ASSESSING SEXUAL DYSFUNCTION
The most important step when assessing patients with FSD is to obtain information just as you would for any other medical problem, paying particular attention to cultural competence skills. Sensitivity toward the patient's ethnic, cultural, and personal background during the medical, sexual, and psychosocial history-taking is imperative for establishing trust. Include FSD-related health information in the chief complaint, if the patient discusses it. If the patient does not discuss her FSD concerns, you should be thorough with your review of systems and inquire about general health and well-being, sleep, and sexual activity. Keep the health literacy of the individual patient in mind, and use appropriate terms and medical models to clarify discrepancies.
The components of a basic evaluation for sexual dysfunction are: (1) a sexual history, including assessment of the patient's overall sexual function; (2) a medical history; (3) a psychosocial history; (4) a focused physical examination; and (5) the recommended laboratory tests to rule out confounding medical conditions. The patient's own assessment of her problem, including her past sexual responses with a partner(s) and/or via self-stimulation is crucial.13
The PA's role No medications have been approved by the FDA to treat FSD based on DSM-IV-TR criteria. Thus, PAs have focused on counseling their patients and ruling out other medical conditions. In the event that a more complex psychosocial issue is uncovered, referral to a sexologist would be appropriate. Medical, psychiatric, family, sexual, and social (relationship and work) histories are part of the care-related
discussions PAs have with patients each and every day. However, PAs should not assume that a patient is sexually active. Therefore, inquiring about general health, sleep patterns, nutrition, and/or psychological health may help "break the ice" before discussing sexual health. Utilizing modeling comments such as, "Many patients tell me they experience sexual problems or concerns. Are you experiencing any sexual problems or concerns?" is a good way to get the conversation started.
A comment that starts out, "My partner wanted me to ask
you ..." is often an indication that the patient has a concern. Many times, the patient just needs reassurance that she is in a secure environment, where no topic is off-limits.
CONCLUSION
PAs are at the forefront of the American health care system. So, the PA is obligated to develop a thorough understanding of a patient's history. This includes a sexual history. Taking a sexual history may help to uncover the onset of a primary sexual dysfunction or a sexual dysfunction secondary to hypothyroidism, depression, anxiety, substance abuse, past sexual/physical abuse, vaginal prolapse, or a pituitary tumor.
FSD affects a great many women and encompasses sexual desire disorders (such as HSDD), FSAD, FOD, and pain disorders. FSD is also multifactorial; it involves the spirit, mind, body, and relationships of the patient. The first step toward helping patients understand and manage their FSD is to engage them in a discussion about their sexual health. PAs are in a prime position to lead this endeavor, as they interact with patients at every level of the health care system and in every specialty. JAAPA
Raymond Cox is Chairman, Department of Obstetrics and Gynecology, Saint Agnes Hospital, Baltimore, Maryland, and immediate past-Chair, American College of Obstetricians and Gynecologists Committee on the Health of Underserved Women. He has no relationships to disclose relating to the content of this article. Laura Moore is Senior Regional Medical Scientist, Boehringer Ingelheim Pharmaceuticals Inc, Ellicott City, Maryland, and practices in obstetrics and gynecology at Saint Agnes Hospital. Boehringer Ingelheim is the developer of flibanserin, an experimental treatment for female sexual dysfunction.
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