A practical guide to female sexual dysfunction: An evidence-based review for physicians in Canada.

Abstract

The evaluation and treatment of male sexual dysfunction has developed considerably since the release of sildenafil (Viagra®) as a treatment for erectile dysfunction in 1998.1 There is a societal perception that it is important for men to preserve their sexual function and optimize their sexual performance. This perception, coupled with perpetual innovation in male sexual medicine, has led to many treatment options for male sexual dysfunction, including oral therapies for erectile dysfunction, multiple vehicles for hormonal replacement, shockwave therapy, and penile implants for refractory erectile dysfunction. There are fellowships throughout Canada dedicated to the medical and surgical management of male sexual dysfunction. Medical students and residents across many disciplines are routinely exposed to the evaluation and treatment of men with sexual dysfunction. Unfortunately, despite robust clinical and academic interest in male sexual dysfunction, women with sexual complaints have been largely overlooked.2 There have been limited treatment options, few Canadian role models who specialize in female sexual medicine, and little academic activity in the area of female sexual function. Fortunately, over the past decade there has been an increase in the clinical and academic interest in female sexual function. The times appear to be changing. The International Society for the Study of Women’s Sexual Health (ISSWSH) was established in 2001 to serve as a multidisciplinary international community dedicated to advancing the study of female sexuality. There are published guidelines and position papers that reinforce the practical aspects of female sexual dysfunction (FSD) evaluation and management.3 There has been an important increase in research regarding the impact of cancer and its treatment on female sexual function.4 And finally, there are now U.S. FDA-approved therapies for both low desire and sexual pain that will possibly be available in Canada in the future.5–7 The increase in attention to female sexual function over the past decade can be attributed to a number of factors, including the establishment of ISSWSH, new treatments offering hope, an increase in female sexuality research, and broader societal forces promoting equity in medical practice and research. This review provides a practical, evidence-based guide to the evaluation and management of FSD that is adaptable for clinical practice in Canada. For the purpose of this review, the classification of FSD have been divided into four broad categories: sexual pain, low desire, low arousal, and orgasmic dysfunction. These closely mirror the DSM V classifications of FSD, compromised of: genito-pelvic pain/penetration disorder (sexual pain), female sexual interest/arousal disorder (low desire and low arousal), and female orgasmic disorder (orgasmic dysfunction). 8 These classifications have been chosen instead of the DSM classifications, as many patients will not meet strict criteria but will still benefit from evaluation and management. A symptom-based approach is the most effective means to organize the initial medical evaluation and treatment of women with sexual complaints to encourage collaboration and communication between healthcare providers.