International Society For The Study Of Women's Sexual Health Research Articles

(119) Provider Habits Regarding Screening for Sexual Dysfunction in Pregnancy at a Tertiary Medical Center in Chicago, IL

Abstract Introduction A national survey of Ob/Gyns illustrates the majority do not routinely inquire about sexual dysfunction, pleasure, or satisfaction despite female sexual dysfunction (FSD) being an issue affecting an estimated 43% of women throughout their lifetime. Moreover, many studies have shown an increase in sexual dysfunction in pregnancy, including a Brazilian study showing 73.3% of women experience sexual dysfunction in their third trimester. No specific guidance exists for providers regarding the timing of screening nor the proper methods of education for sexual dysfunction in pregnancy. The International Society for the Study of Women’s Sexual Health (ISSWSH) detailed that certain sexual dysfunction disorders have numerous publications, yet lack of concise screening resources to aid the clinician in detection and management. Objective This study evaluated screening and education practices for sexual dysfunction in pregnancy at a tertiary medical center in a low-risk population. Methods From 2018 to 2021, an average of 1284 women received prenatal care at our institution annually. This study randomly reviewed 113 charts from patients receiving prenatal care with our low-risk providers. We conducted a retrospective chart review, collecting data including: pre-existing conditions, Edinburgh Postpartum Depression Screen (EPDS) scores, and characteristics of both the provider and the type of sexual dysfunction present. Results Of 113 pregnant women in our sample, 19% (N=21) were screened for sexual dysfunction throughout the course of their pregnancy and postpartum visits. There were no notable differences in screening habits based on patient age, Gravida, Para, BMI, marital status, or pregnancy complications. At any time, the median EPDS score for those screened for FSD was consistently greater compared to those who were not screened. Patients were more commonly screened by attendings (71%, N=15) rather than residents (29%, N=6) or APNs (10%, N=2). Patients were most commonly screened postpartum (N=13). No women were screened in the third trimester. Of the 21 who were screened, 76% (N=16) screened positive for sexual dysfunction. The majority of those with FSD had myofascial pain (N=9). A quarter had dyspareunia (N=4). Of those with FSD, 19% (N=3) were educated on sexual dysfunction postpartum. Conclusions Our chart review revealed that less than 20% of patients were screened for sexual dysfunction over the course of their pregnancy, including the postpartum period. We found no evidence of education provided on sexual dysfunction in pregnancy. Of those screened, the prevalence of sexual dysfunction was 76%. There were no notable changes in screening habits based on the specific patient characteristics studied or demographics, however screening tended to be more prevalent in patients with increased EPDS scores. At our institution, attending physicians more frequently screen for FSD over resident physicians or APNs in our practice. Postpartum was the most popular time to screen. Prenatal sexual dysfunction occurs most prominently in the third trimester, but we found no evidence of screening being performed during this time. Disclosure No

(065) Let’s Talk about Sex: Resident Run Didactic Curriculum

Abstract Introduction The Council on Resident Education in Obstetrics and Gynecology (CREOG) includes sexual health learning objectives as part of the core education for Ob/Gyn training. Residents are expected to gain understanding of normal sexual function as well as common areas of sexual dysfunction. Unfortunately, several studies have demonstrated a lack of knowledge in this area by Ob/Gyn residents and that educational didactic programs are not standardized on this topic. In 2010, over 90% of post graduate year (PGY)3 and PGY4 residents reported attending fewer than 5 didactic activities on sexual function/dysfunction, with only 50% feeling able to perform a targeted physical exam. Over the past decade, there has not been substantial improvement in this subject matter. In a 2021 survey evaluating the sexual health CREOG objectives showed that more than half of Ob/Gyn residents were not able to describe the disorders of sexual function or list common medications that effect sexual function. This is not isolated to the US, with studies in other countries including Singapore and Brazil, showing residents lack formal training and residents want increased didactic time focused on sexual health. Objective Our hypothesis was that at our institution the baseline knowledge of sexual dysfunction among Ob/Gyn residents would be low. The primary objective was formulating a needs assessment through implementation of a pre/post survey with a curriculum component. The secondary objective was to determine what areas of sexual medicine are most commonly areas of confusion or where residents lack comfort in regard to patient care. Methods The resident-designed curriculum was built with collaboration from a pelvic floor physical therapist. The journal club format was based on American College of Obstetricians and Gynecologists (ACOG) Practice Bulletins, the International Society for the Study of Women’s Sexual Health (ISSWSH) clinical pearls, and the North American Menopausal Society (NAMS) position statements. The pelvic floor physical therapy component focused on pelvic pain, perinatal considerations, and incontinence. The WCG IRB deemed this study exempt. After the pre-curriculum assessment was used to identify knowledge gaps, a month of one-hour weekly sexual health sessions were implemented followed by a post-curriculum survey. Results Due to small sample size, (N=14) there was no way to establish significance in our results. In general, areas that residents were weak and the curriculum focused on were: 1) Pelvic floor/vulvar/vestibular disorders. 2) Genitourinary syndrome of menopause and vasomotor symptoms of menopause. 3) Sexual medicine disorders (hypoactive sexual desire disorder, female sexual arousal disorder, persistent genital arousal disorder, female orgasm disorders, genitopelvic pain penetration dysfunction). Conclusions The baseline knowledge of sexual dysfunction and menopausal concerns among Ob/Gyn residents was low. However, implementation of a structured curriculum after a formal needs assessment improved comfort with these topics. Now that the baseline curriculum is designed it is imperative to expand to further residency programs (in Ob/Gyn as well as other specialties) to disseminate the knowledge to providers in training who require competency in sexual health concerns. Disclosure No

Jack of all trades-master of most.

The Sandra R. Leiblum Presidential Lecture, delivered by the president at the time of the annual meeting, is named for the first president of the International Society for the Study of Women’s Sexual Health (ISSWSH), who passed away tragically in 2010. I was pleased to present this address at the ISSWSH Annual Meeting on March 6, 2023, in St Louis, Missouri, and to share it with our Sexual Medicine Reviews readers. Welcome to St Louis, founded in 1764 as a French fur-trading village by Pierre Laclede, who named the city “St Louis” for King Louis IX. It is famous for its beer, baseball, and the Blues hockey team. Foods invented here include the hamburger, the hot dog, peanut butter, iced tea, the club sandwich, cotton candy, and the ice cream cone—all of which premiered at the 1904 World’s Fair. As St Louis was the western-most city in the new territory in 1803 with the Louisiana Purchase, it became known as the “gateway to the west,” perpetuated today by the famous Gateway Arch. When Irwin and I moved from Boston to San Diego, we drove for 2 days to get to St Louis and bought a National Parks Pass, and the Gateway Arch was my first national park ever.

International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)

BackgroundPersistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. AimTo characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. MethodsA panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. OutcomesThe nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. ResultsThe panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients’ symptoms and the associated bother and distress. Clinical ImplicationsThe process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and LimitationsStrengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. ConclusionWe provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized.Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665–697.

The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD.

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art. To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs. We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization. The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification. ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs. These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, etal. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

The International Classification of Diseases, 11th Revision: A Step-Back for Women With Vulvodynia?

The aim of the study was to compare the International Classification of Diseases, 11th revision, (ICD-11) with current terminology of vulvodynia, approved by a broad-based consensus of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS). The diagnostic criteria and descriptions of vulvodynia as well as the definition and classification of chronic pain in ICD-11 were reviewed and compared with the Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia, endorsed in 2015 by the ISSVD, ISSWSH, and IPPS. Diagnostic criteria and descriptors of vulvodynia in the ICD-11 are outdated. Moreover, vulvodynia is not identified among chronic pain diagnoses, despite fulfilling the diagnostic criteria of chronic primary pain. Specifically, vulvodynia is a vulvar pain of at least 3-month duration, which is associated with significant emotional distress and functional disability, and is not better accounted for by another specific condition. The ICD-11 is not aligned with current vulvodynia diagnostic criteria and terminology, approved by the ISSVD, ISSWSH, and IPPS. Collaboration among the International Association for the Study of Pain Task Force on Classification of Chronic Pain, ICD team, ISSVD, ISSWSH, and IPPS is needed to harmonize terminologies, codes, and clinical approach regarding vulvar pain and vulvodynia classification.

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III

IntroductionIn 2016 the International Society for the Study of Women’s Sexual Health (ISSWSH) published an expert consensus report on new nomenclature that addressed the need for comprehensive, evidence-based criteria for new diagnoses in desire, arousal, and orgasm, with the definition on arousal focusing exclusively on female genital arousal disorder (FGAD). AimA new expert panel solely focused on mechanisms of arousal disorders convened to revise the nomenclature to include female cognitive arousal disorder (FCAD) and FGAD. MethodsThe ISSWSH co-chairs identified experts on arousal disorders in women. The 10 participants included clinicians, researchers, and educators, representing a diverse, multidisciplinary group. Pre-meeting preparation included evidence-based literature review as the basis of presentations panelists made at the meeting on the current knowledge in cognitive arousal. Consensus was reached using a modified Delphi method. Writing assignments were made as a basis of manuscript development. Main Outcome MeasuresThe new definition of FCAD is characterized by distressing difficulty or inability to attain or maintain adequate mental excitement associated with sexual activity, as manifested by problems with feeling engaged and mentally turned on or sexually aroused for a minimum of 6 months. ResultsFemale sexual arousal disorder encompasses both FGAD (revised definition) and FCAD (new definition). Recommendations regarding diagnosis include a clinical interview to assess for FCAD using targeted questions. Patient-reported outcomes that contain questions to assess FCAD are described, including limitations for differentiating between cognitive arousal, genital arousal, and sexual desire. Laboratory measures of cognitive and genital arousal are discussed, including the relationships between genital and cognitive arousal patterns. Biopsychosocial risk factors for FCAD and FGAD, as well as exclusionary conditions, are presented. Clinical ImplicationsThe revision of the ISSWSH nomenclature regarding the criteria for the 2 arousal categories, FCAD and FGAD, and the recommended diagnostic strategies offers a framework for management of women with arousal disorders. Strengths & LimitationsThis nomenclature allows for basic science and clinical research in subtypes of arousal in order to develop better diagnostic and treatment options for use by clinicians, scientists, and regulatory agencies. There are limited validated measures of cognitive arousal, including the Female Sexual Function Index, the most commonly used measure, which does not effectively distinguish between cognitive excitement, genital sensations, and event-related desire. ConclusionFuture directions include the refinement of FCAD and FGAD and development and validation of patient-reported outcomes that distinguish between the cognitive processes and genital responses to enhance clinical care and research in this area.Parish SJ, Meston CM, Althof SE, et al. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part III. J Sex Med 2019;16:452–462.

Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society).

Three scientific societies, the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) developed the "2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia" (referred to as the "2015 consensus terminology").The terminology included 11 descriptors of vulvodynia. However, the definitions of the descriptors were not included in the 2015 consensus terminology publications. The objective of this article was to provide these definitions. The ISSVD led a discussion on the definitions for the 11 vulvodynia descriptors, with participation from the ISSWSH and IPPS. The definitions were created through a consensus process. The definitions are described and the rationale for their choice is elucidated. The definitions of vulvodynia descriptors were determined by a multistaged process of discussion among health care providers with expertise in the pathophysiology, evaluation, and treatment of vulvodynia. The definitions were approved by the ISSVD, ISSWSH, and IPPS. It is recommended that these definitions of vulvodynia descriptors as well as the 2015 consensus terminology be used for the classification of vulvodynia.

Position statement by Experts of the Polish Menopause and Andropause Society, and the Polish Society of Aesthetic and Reconstructive Gynaecology on the medicinal product Intrarosa®.

A set of menopause-related symptoms affecting the external genitalia and lower urinary tract is discussed in contemporary scientific literature under the name of urogenital atrophy (UGA) or vulvovaginal atrophy (VVA) [1]. In 2014, a team of experts from two scientific associations – The North American Menopause Society (NAMS) and The International Society for the Study of Women’s Sexual Health (ISSWSH) – proposed a new terminology for postmenopausal atrophic symptoms, replacing the terms VVA and UGA with the term genitourinary syndrome of menopause (GSM) [2]. The change was motivated by the belief that this set of symptoms requires a more holistic therapeutic approach falling outside the scope of interest of gynaecologists and urologists only. The signs and symptoms of GSM are summarised in the Table 1. Table 1 Genitourinary syndrome of menopause (GSM) –symptoms and signs

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

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.

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part II

IntroductionCurrent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) definitions of sexual dysfunction do not identify all sexual problems experienced clinically by women and are not necessarily applicable for biologic or biopsychosocial management of female sexual dysfunction. A unified nomenclature system enables clinicians, researchers, and regulatory agencies to use the same language and criteria for determining clinical end points, assessing research results, and managing patients. AimTo develop nomenclature with classification systems for female sexual desire, arousal, and orgasm disorders with definitions pertinent to clinicians and researchers from multiple specialties who contribute to the field of sexual medicine. MethodsKey national and international opinion leaders diverse in gender, geography, and areas of expertise met for 2 days to discuss and agree to definitions of female sexual desire, arousal, and orgasm disorders and persistent genital arousal disorder. The attendees consisted of 10 psychiatrists and psychologists; 12 health care providers in specialties such as gynecology, internal medicine, and sexual medicine; three basic scientists; and one sexuality educator, representing an array of societies working within the various areas of sexual function and dysfunction. Main Outcome MeasureA unified set of definitions was developed and accepted for use by the International Society for the Study of Women’s Sexual Health (ISSWSH) and members of other stakeholder societies participating in the consensus meeting. ResultsCurrent DSM-5 definitions, in particular elimination of desire and arousal disorders as separate diagnoses and lack of definitions of other specific disorders, were adapted to create ISSWSH consensus nomenclature for distressing sexual dysfunctions. The ISSWSH definitions include hypoactive sexual desire disorder, female genital arousal disorder, persistent genital arousal disorder, female orgasmic disorder, pleasure dissociative orgasm disorder, and female orgasmic illness syndrome. ConclusionDefinitions for female sexual dysfunctions that reflect current science provide useful nomenclature for current and future management of women with sexual disorders and development of new therapies.

Non-Medical, Medical, and Surgical Approaches for the Treatment of Provoked Vestibulodynia

Though a large number of women suffer from vulvar pain and dyspareunia, many clinicians feel that they lack the knowledge to adequately evaluate, diagnose, and treat women with vulvovaginal pain. This review examines the new International Society for the Study of Vulvovaginal Disease (ISSVD)/International Society for the Study of Women’s Sexual Health (ISSWSH)/International Pelvic Pain Society (IPPS) terminology of vulvar pain and vulvodynia, reviews a diagnostic algorithm that can help to differentiate between different types of vulvar pain, and discusses non-medical, medical, and surgical treatment options for provoked vestibulodynia (PVD; vulvodynia confined to the vestibule). The combination of this new terminology, diagnostic algorithm, and potential treatments will allow for more appropriately targeted treatments for women with PVD.

2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia.

In 2014, the Executive Council of the International Society for the Study of Vulvovaginal Disease (ISSVD), the Boards of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) acknowledged the need to revise the current terminology of vulvar pain, based on the significant increase in high quality etiologic studies published in the last decade. The new terminology was achieved in four steps. The first involved a terminology consensus conference with representatives of the three societies, held in April 2015. Then, an analysis of the relevant published studies was used to establish a level of evidence for each factor associated with vulvodynia. The terminology was amended based on feedback from members of the societies. Finally, each society's board accepted the new terminology. In 2015, the ISSVD, ISSWSH, and IPPS adopted a new vulvar pain and vulvodynia terminology that acknowledges the complexity of the clinical presentation and pathophysiology involved in vulvar pain and vulvodynia, and incorporates new information derived from evidence-based studies conducted since the last terminology published in2003.

Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.

The terminology for the genitourinary tract symptoms related to menopause was vulvovaginal atrophy, which does not accurately describe the symptoms nor is a term that resonates well with patients. In 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause. The two societies cosponsored a terminology consensus conference, which was held in May 2013. The development of a new terminology that more accurately described the genitourinary tract symptoms related to menopause. Members of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. The term GSM was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology--genitourinary syndrome of menopause--in 2014.

Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society

BackgroundIn 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause. MethodsThe 2 societies cosponsored a terminology consensus conference, which was held in May 2013. Results and conclusionMembers of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. The term was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology—genitourinary syndrome of menopause (GSM)—in 2014.

Why sexual medicine?

Welcome to the inaugural issue of Sexual Medicine (SM), the open access, online journal of the International Society of Sexual Medicine (ISSM). SM joins The Journal of Sexual Medicine (JSM) and the newly minted Sexual Medicine Reviews (SMR) to form a family of journals published by and for the ISSM. All three publications are official journals of the ISSM, its five regional affiliate societies, and the International Society for the Study of Women's Sexual Health (ISSWSH).

Report on ISSWSH Fellowship

C for female sexual wellness and the diagnosis and treatment of female sexual dysfunction has led to its becoming a subspecialty in medical care over the past several decades. The small multidisciplinary group of 355 who first convened in Boston in 1999 as “The Female Sexual Function Forum” has grown to become The International Society for the Study of Women’s Sexual Health (ISSWSH), a robust international society of over 725 active members from 29 countries. The members of the society are reflective of the diversity and complexity within the field of female sexual health, and include: physicians (from diverse backgrounds: gynecology, urology, endocrinology, oncology, internal medicine, family medicine, psychiatry), nurse practitioners in women’s health, psychologists, counselors, sex therapists, physical therapists. ISSWSH is a multidisciplinary academic and scientific organization whose purposes are:

The Journal of Sexual Medicine: Sexual Pain Leader or Vulvar Disorder Follower

Each month we are challenged with crafting another issue of The Journal of Sexual Medicine (JSM). The monthly task at hand is to assemble an issue including a wide variety of male and female sexual medicine contributions. At the end of the day, your JSM issue needs to fit the criteria of being interesting, stimulating, educational, and expansive to the overall sexual medicine community and, in particular, to the members of International Society for Sexual Medicine (ISSM) and the International Society for the Study of Women's Sexual Health (ISSWSH). Thus, the mission requires inspecting the current accepted pool of manuscripts, bugging the chairs of JSM Highlights to make sure the special features are ready for production, and writing a JSM editorial. Usually the editorial flows off the tongue—or out of the typing fingers as it were. Occasionally, however, it becomes a struggle to provide you with a provocative piece. This month the process has felt painful, so that seemed like the perfect theme—pain.

2010 Sandra Leiblum Presidential Address

The Journal of Sexual Medicine (JSM) as the official publication of the International Society for the Study of Women’s Sexual Health (ISSWSH) is pleased to publish this special and passionate report, the 2010 Sandra Leiblum Presidential Address, given by Dr. Sheryl A. Kingsberg, as President of ISSWSH. Dr. Sandra Leiblum was the first ISSWSH President, former JSM Board member, frequent JSM reviewer, and regular JSM author on key significant sexual medicine contributions. Subsequent ISSWSH presidents have also been board members and contributors to the JSM. In honoring such special sexual medicine investigators and JSM contributors, your JSM disseminates the critical, essential, and emotionally relevant information that YOU need to know about the field of sexual medicine. Irwin Goldstein, MD

Synthèse pour la rééducation périnéo-sphinctérienne

The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art.To summarize the evidence and interactive and chronological process by which sexual medicine societies’ consensus groups developed the current nomenclature, classifications, and definitions for FSDs.We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women’s Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization.The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification.ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs.These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies.Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36–56.