Female Sexual Dysfunction (FSD)

NAME:GIRIJA WAGH
MD FICOG FICS DIP IN GYN ENDOSCOPY …
DESIGNATION:PROFESSOR OBGYN
ORGANISATION:BHARATI VIDYAPEETH UNIVERSITY MEDICAL
COLLEGE
CONSULTANT CLOUDNINE / APOLLO HOSPITALS PUNE
DIRECTOR GIRIJA HOSPITAL AND FERTILITY CENTER,KOTHRUD
WWW.DRGIRIJAWAGH.COM
PROFESSIONAL BRIEF & AWARDS:
➢ TRUPTA UMRANIKAR AWARD FOR FIRST IN MD 1992 ,PUNE
UNIV
➢ ANANDIBAI JOSHI AWARD FOR EXCELLENCE IN MEDICAL
SERVICE
➢ SPECIALIZATION : MATERNAL FETAL MEDICINE ,GYN
ENDOSCOPY
➢ MEMBER OF THE STEERING COMMITTEE WORLD
ORGANISATION GESTOSIS
➢ ASST COORDINATOR NATIONAL ECLAMPSIA REGISTRY
➢ CHAIRMAN MEDICAL DISORDERS IN PREGNANCY
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here>

09-04-2019www.drgirijawagh.com 9422000584 2

FEMALE SEXUAL
DYSFUNCTION :DIAGNOSIS
& MANAGEMENT
ISAR 2019
PROF GIRIJA WAGH

Introduction and overview : FSD
Sexual problems are highly prevalent in wo
40% women worldwide report
12 percent report distressing sexual problems
Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008; 112:970.
Sarwer DB, Durlak JA. A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther 1997; 23:87.
Dhikav V, Karmarkar G, Gupta R, et al. Yoga in female sexual functions. J Sex Med 2010; 7:964.
Pace G, Silvestri V, Gualá L, Vicentini C. Body mass index, urinary incontinence, and female sexual dysfunction: how they affect female postmenopausal health.
Menopause 2009; 16:1188.
Bond DS, Wing RR, Vithiananthan S, et al. Significant resolution of female sexual dysfunction after bariatric surgery. Surg Obes Relat Dis 2011; 7:1.

Female sexual dysfunction refers to a sexual problem associated
with personal distress.
It takes
different
forms :
Including lack of sexual desire
Impaired arousal
Inability to achieve orgasm
Pain with sexual activity
Sexual dysfunction may be a problem since the
start of sexual activity or may be acquired later in
life after a period of normal sexual functioning.
Sexual dysfunctions. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, American Psychiatric Association, Arlington 2013.

Interpersonal
context
Sexual Pain Disorders
GUS of Menopause (VVA)
Pelvic floor hyper tonus
(Vaginismus: old term)
Other forms of dyspareunia

FEMAE SEXUAL RESPONSE
THE PARADIGM SHIFT
OLD PARADIGM
EMERGING PARADIGM
INTIMACY NEEDS
NEED OF SEXUAL
RESPONSIVENESS
SENSE OF
INTIMACY LOVE
AFFECTION
SATISFACTION
ORGASMIC AND
NONORGASMIC
09-04-2019
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8

EVIDENCE
• IN THE WOMEN'S INTERNATIONAL STUDY OF
HEALTH AND SEXUALITY (WISHES), A
QUESTIONNAIRE STUDY OF OVER 2000 WOMEN
• Low sexual desire with distress
was associated with emotional
and psychological distress
• Lower sexual and partner
satisfaction
• Decrements in general health
status, including aspects of
mental and physical health
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www.drgirijawagh.com 9422000584 4/9/2019 10

SEXUAL H/O
questionnaire
Non
judgemental
Open-ended
Non
assumptive
Partner
perceptions

SEXUAL RESPONSE
DISORDERS : USUALLY >1
PHASES AFFECTED
4/9/2019www.drgirijawagh.com 9422000584 17
Interest /arousal disorder
Orgasmic disorder
Genitopelvic pain /penetration /pain disorder
Medication induced SD
Unspecified SD

4/9/2019Sample Footer Text 22

FSD : DIAGNOSTIC CRITERIA
• RECURRENT /PERSISTENT
• PERSONAL DISTRESS /INTERPERSONAL DIFFICULTY
• D/D : DEPRESSION : UNACCOUNTABLE

Diagnostic and Statistical Manual Version 5 (DSM-5)

GYNEC
H/O &
SYST/E
• Menopausal status (natural, surgical, or
following chemotherapy or pelvic radiation)
• Pregnancy and childbirth history
• History of vulvovaginal or pelvic injury,
cancer, or surgery
• Vulvovaginal or pelvic pain
• Vulvovaginal pruritus, dryness, or discharge
• Abnormal genital tract bleeding
• Urinary or fecal incontinence
4/9/2019 www.drgirijawagh.com 9422000584 25

STRESS / OBESITY /DIABETES

“Viagra for women” ?
.Viagra helps men who already want to have sex but
are not able to physiologically.
Addyi changes brain chemistry in women to help
them want to want to have sex.
Viagra is taken on an as needed basis to help
increase blood flow to the penis.
Addyi must be taken every day for an undetermined
amount of time to be even minimally effective.

• In a longitudinal study of over 400 women studied across the
menopausal transition, sexual response was predicted by prior
level of sexual function, change in partner status, and feelings for
partner, demonstrating that relationship factors were more
important than hormonal determinants of sexual function for
midlife women
• Similarly, when examining correlates of sexual function among
multi-ethnic middle-aged women in the study of women's health
across the nation (SWAN), variables having the greatest association
included relationship factors
Dennerstein L, Lehert P, Burger H. The relative effects of hormones and relationship factors on sexual function of women through the
natural menopausal transition. Fertil Steril 2005; 84:174.
Avis NE, Zhao X, Johannes CB, et al. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of
Women's Health Across the Nation (SWAN). Menopause 2005; 12:385.

In a national probability sample
of almost 1000 women aged 20
to 65 years, the best predictors
of sexual distress were markers
of general emotional well-being
and relationship with a partner
Bancroft J, Loftus J, Long JS. Distress about sex: a national survey
of women in heterosexual relationships. Arch Sex Behav 2003;
32:193.

IT IS
IMPORTA
NT TO
ASK
ABOUT SD
• 1000 Women PRESENTING FOR A primary
CARE VISIT : 98 % REPORTED 1/MORE
CONCERN BUT ONLY 18% CINICIANS asked
ABOUT SEXUAL HEALTH
• PRESIDE STUDY : Prevalence of female sexual
problems associated with distress and
determinants of treatment seeking : OUT OF
3000 women with distressing sexual problem
: 6% sought medical advice while 80% the
woman initiated the discussion
Shifren JL, Johannes CB, Monz BU, et al. Help-seeking behavior of women with self-reported
distressing sexual problems. J Womens Health (Larchmt) 2009; 18:461.

IT IS
PERTINEN
T TO ASK
• ARE YOU CURRENTLY SEXUALLY ACTIVE?
• DO YOU NEED CONTRACEPTION OR
PRECONCEPTIONAL COUNSELING?
• ARE YOU PRACTICING SAFE SEX?
• WOULD YOU LIKE TO BE SCREENED FOR
SEXUALLY TRANSMITTED INFECTIONS?
• DO YOU FEEL SAFE IN YOUR
RELATIONSHIP?
• ARE YOU CURRENTLY EXPERIENCING OR
HAVE YOU EVER EXPERIENCED SEXUAL
ABUSE OR ASSAULT?

www.drgirijawagh.com 9422000584 09-04-2019 38

PELVIC
EXAM
ESPECIALLY SEXUAL PAIN DISORDERS
confirm normal pelvic anatomy
assess for genital or pelvic tenderness
Lesions
pelvic organ prolapse
pelvic floor hypertonus
vulvovaginal atrophy.
vaginal discharge or abnormal bleeding

LABORATORY
INVESTIGATIO
NS
• Androgen levels should NOT be used
to determine the cause of a sexual
problem, as serum androgen
concentrations do not appear to be an
independent predictor of sexual
function in women
• Available laboratory assays for the low
serum androgen levels seen in women
are often unreliable
• Similarly, testing estradiol or other
hormones (eg, follicle stimulating
hormone) has no utility in evaluating
sexual complaints.
• Menopause is best diagnosed
clinically.4/9/2019 www.drgirijawagh.com 9422000584 40

• Sexual function issues should be
addressed as part of every
comprehensive women’s health visit.
Unfortunately, most sexual problems
in women remain unrecognized and
untreated.
• Asking a patient whether she has a
sexual concern is easily incorporated
into a clinician's questions about
gynecologic health,

Female Sexual Dysfunction (FSD)

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