Treatment Of Female Sexual Dysfunction Research Articles

Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review.

Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction. In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions. Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review. Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence. Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework. This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field. Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.

New management approaches for female sexual dysfunction.

The goal of this paper is to review the most recent studies evaluating treatments for female sexual dysfunction (FSD), including distressing symptoms of desire, arousal, and orgasm disorder. We divide the sections into psychological and pharmacological. There is excellent evidence in favour of mindfulness, cognitive behavioural therapy, and psychoeducation for improving low sexual desire in women, and less evidence in support of these approaches to address other sexual dysfunctions in women. There are two US Food and Drug Administration (FDA) approved pharmacological treatments for low desire in premenopausal women that have modest benefits above placebo, and a significant proportion of users will experience side effects. Evidence also supports the use of transdermal testosterone for low desire in postmenopausal women. Sexual dysfunction in women is common and distressing, and there are a variety of psychological and pharmacological treatments. More research is needed to better understand the predictors of a positive treatment response in order to deliver more personalized care.

The use of phosphodiesterase inhibitors in the treatment of female sexual dysfunction: scoping review.

The purpose of this study was to analyze the available evidence regarding the efficacy of iPDE5 in the treatment of female sexual dysfunction (FSD). A comprehensive literature search was conducted in March 2023 through the main scientific databases. A total of 53 articles were identified, out of which, 6 met the predefined inclusion criteria. All of these were randomized controlled trials. Among the included studies, 4 demonstrated the effectiveness of sildenafil in improving sexual response and addressing FSD, while 2 studies failed to establish its efficacy in this context. Overall, the efficacy of sildenafil in the treatment of FSD remains controversial and inconclusive based on the available evidence. Further research is necessary to clarify the therapeutic potential of iPDE5 in addressing FSD and to better understand the factors that influence treatment outcomes.

(092) SEXUAL EXPERIENCES IN AN EXPLORATORY, PHASE 2B, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRIAL OF SILDENAFIL, 3.6% CREAM FOR THE TREATMENT OF FEMALE SEXUAL AROUSAL DISORDER

Abstract Introduction Quantifying the change in the mean number of satisfactory sexual experiences (SSEs) is an efficacy endpoint recommended by the US Food and Drug Administration in studies of treatments for female sexual dysfunctions (FSD), including female sexual arousal disorder (FSAD). Objective Post-hoc analysis of sexual experiences in a study of Sildenafil Cream, 3.6% for treatment of FSAD Methods Phase 2b, exploratory, randomized, placebo-controlled, double-blind study of Sildenafil Cream, 3.6% among premenopausal women with FSAD (NCT04948151). Following a baseline, single-blind, placebo, run-in period, participants were randomized and used investigational product (IP) at home for 12 weeks. Between monthly, in-clinic assessments, participants answered questions in an electronic diary (eDiary), within 24-hours of each sexual experience. Sexual experiences were categorized as “Partnered” versus “By Myself” and “Satisfactory” versus “Not Satisfactory”. eDiary question 11 (Q11) asked “Were conditions appropriate for satisfactory sexual activity (enough time, no distractions, etc.)?”. Changes from baseline in the mean number of SSEs was a secondary efficacy endpoint. The Orgasm domain (questions 22-24) of the Sexual Function Questionnaire (SFQ28) was an exploratory efficacy endpoint. Un-partnered women and women with sexual partners who did not sign informed consent were enrolled in the study, but in these cases (n=15), IP was only used in solo sexual experiences. Results Sildenafil Cream users had more sexual experiences and more un-partnered sexual experiences during the double-blind treatment period compared to Placebo Cream users. Sildenafil Cream users were significantly more likely to engage in sexual experiences even when conditions were not appropriate for a satisfactory experience. Although, the change from baseline in the mean number of SSEs at week 12 decreased during solo, un-partnered sexual experiences for both product groups (-0.12±0.27 for Sildenafil versus -0.04±0.32 for Placebo, p=0.85), during the double-blind treatment period, Sildenafil Cream users reported significantly higher proportions of SSEs during un-partnered sexual experiences (197/261, 75.5%) compared to Placebo users (116/187, 62.0%) (p=0.002). Despite Sildenafil Cream users engaging in a sexual experience more frequently when conditions were not appropriate, the proportion of SSEs during these events when Q11=“No” were not different between active (17/59, 28.8%) versus placebo (8/25, 32.0%) users (p=0.77). Finally, un-partnered women and women with un-enrolled sexual partners, who by definition had only solo sexual experiences, had an increase from baseline in their SFQ Orgasm at week 12 with Sildenafil use (2.58±1.13) versus Placebo users in this subset, who had decreases in this score (-0.34±1.13) (p=0.13). Conclusions These data support that Sildenafil Cream 3.6% enhanced solo, un-partnered sexual experiences, which represented approximately 1 in 5 events in this FSAD treatment study. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Science and Technologies LLC Clarification: Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and Strategic Science and Technologies LLC.

(074) THE REPRESENTATION OF FEMALE SEXUAL MEDICINE AND GENITAL ANATOMY IN A USMLE STEP 1 RESOURCE

Abstract Introduction Sexual health is an essential component of overall health and wellness. Sexual dysfunction is pervasive and there are barriers to adequate diagnosis and treatment, including lack of instruction for medical students. Previous work from our group assessed the curricula of all seven medical schools within the Chicago area and highlighted the need to standardize both preclinical and clinical materials to enhance student education, exposure, and preparation in female sexual medicine (FSM). The United States Medical Licensing Exam (USMLE) Step 1 significantly informs content of pre-clinical undergraduate medical education. Comprehensive USMLE Step 1 resources therefore assume an integral role in exposing medical students to key topics which may or may not be included in their individual school’s curriculum. Thus, it is important to assess if information about FSM and female genital anatomy is delivered to medical students and to what extent in board exam materials. Objective This study aims to assess the coverage of sexual medicine topics in a USMLE Step 1 resource and to compare the representation of male- versus female-specific content. Methods Digital copies of First Aid for the USMLE Step 1 2020-2023 versions were collected and evaluated for inclusion of sexual medicine subjects and topics for both males and females. The content of the chapters titled “Reproduction” and “Psychiatry” were included. To standardize our data collection, existing literature was used to identify specific components of anatomy and physiology related to genital anatomy and orgasm. Additionally, the epidemiology, pathologies, and treatments of FSM were specifically searched for in this resource. Results Across the four editions of the resource included for evaluation, all covered the physiology of the male orgasm, however, none included the physiology of the female orgasm. Moreover, the only mention of female sexual dysfunction (FSD) was in the psychiatry chapter which only briefly addressed the pathophysiology of FSD, but not the epidemiology nor the treatment of FSD. Furthermore, only one out of seven relevant anatomical terms describing parts of clitoral anatomy were included. Homologous male genitalia was consistently labeled for the glans penis, prepuce, corpora cavernosa, and corpus spongiosum as four out of six anatomical terms of interest. Additionally, all four editions from 2020-2023 included content on penile neurovasculature and a penile cross-sectional diagram; however, there was no mention of clitoral neurovasculature nor were there any cross-sectional diagrams of female anatomic components in any of the four editions evaluated. Conclusions Despite this USLME Step 1 resource’s over 840 pages, the representation of topics related to FSM is lacking compared to analogous male topics. Recent literature which has highlighted the gaps in FSM education and the importance of comprehensive sexual medicine training for physicians, however, there have been no significant changes to the content of this resource over the past four editions. USMLE Step 1 resources play a vital role in enhancing the understanding of FSM among medical students. Content expansion is needed to provide accurate information to patients, help patients make informed decisions about treatments, destigmatize reproductive and sexual health, and overall advance medical knowledge of FSM. Disclosure No.

Efficacy of Group Psychotherapies for the Treatment of Female Sexual Dysfunction: A Systematic Review

Efficacy of Group Psychotherapies for the Treatment of Female Sexual Dysfunction: A Systematic Review

Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review.

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p < 0.05) and UDI-6 (p < 0.01) in the midurethral sling group compared to the PRP injections group. Regarding the risk of bias, the RCT was characterized by high risk, whereas the observational studies were of moderate risk. The protocol for PRP injections for FSD is the injection of 2 mL of PRP into the distal anterior vaginal wall once a month for 3 months. For female SUI, 5-6 mL of PRP should be injected into the periurethral area once a month for 3 months. Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI.

Acupuncture modification treatment for female sexual dysfunction: A meta-analysis

BackgroundAcupuncture has potential in the treatment of female sexual dysfunction (FSD), but its effectiveness needs to be verified. AimA meta-analysis to provide a summary of studies that had investigated the efficacy of acupuncture as a treatment for FSD. MethodsA systematic screening was conducted on electronic databases such as Pubmed, Embase, Cochrane Library, CNKI, and CBM to select studies that met the criteria before April 2023. We only included those studies assessing women’s sexual functioning by the Female Sexual Function Index (FSFI). OutcomesBy calculating the relative risk (RR) using the standardized mean difference (SMD) and 95% confidence interval (CI), these data were combined to generate a summary of the findings. The pooled results were calculated using a random-effects model. ResultsA total of 4 studies involving 178 participants were included, and the comprehensive results indicated a significant difference in FSFI scores between the acupuncture group and the control group. In the desire and arousal scale, there was a statistically significant difference between the acupuncture group and the control group. But in the scale of lubrication, orgasm, satisfaction, and pain, there was no statistically significant difference between the two groups. ConclusionA comparison of overall FSFI scores, sexual desire, and sexual arousal revealed that acupuncture treatment can improve female sexual dysfunction to some extent. However, in terms of vaginal lubrication, orgasm, sexual satisfaction, and sexual pain, acupuncture treatment did not significantly improve female sexual dysfunction. In the future, it is necessary to include more RCT trials and expand the number of patients analyzed to make the conclusions more reliable.

Chinese expert consensus on diagnosis and treatment of female sexual dysfunction (2023 version)

Chinese expert consensus on diagnosis and treatment of female sexual dysfunction (2023 version)

Sexual Dysfunction in a Sample of Women Having Infertility and Its Impact on Quality of Life

Conflict of interest None of the above authors have any conflict of interest to disclose. Background Female sexual disorders are prevalent disorder which is underdiagnosed due to cultural barriers in seeking help in management, having huge impact on mental health quality of life. The studies investigating the impact of infertility on female sexual dysfunction are scarce, but they have consistently demonstrated that sexual complaints are very common among infertile women. Sometimes appropriate treatment of female sexual dysfunction can preclude the use of expensive and unnecessary treatment for infertility. This study will compare sexual dysfunction and quality of life among infertile women and fertile women. Aim of the Work To assess the female sexual function among infertile women and comorbid psychiatric disorders among infertile women. Subjects and method: This is cross sectional study, which was conducted on random sample of 168 infertile females and 167 fertile females, attending outpatient infertile clinic, and the gynaecology outpatient clinic, Ain Shams University hospital, the study started September 2017 until February 2019, all females who fulfil inclusion criteria were subjected to SCID-I, The Arabic version of (FSFI), The Arabic version of PCASEE. Results there was a statistically significant relationship between female sexual dysfunction among infertile group and fertile group, in the infertile group, 123 females (73.2%) of the infertile females did not have mental disorder and 45 females (26.7%) had mental disorder, 19 females (11.3%) of them had anxiety disorder (generalized anxiety disorder, social phobia, and panic disorder) and 26 females (15.5%) of them had major depression disorder. Conclusion There is high prevalence of female sexual dysfunction among the infertile female group, and there was strong association between infertility, sexual dysfunction and developing comorbid psychiatric disorder. Further assessments should be considered in the infertility clinic, proper documentation as well. Management should include psychotherapy, lubricants, targeted sexual-therapy and pharmacological treatment. Abbreviation SCID-I: Structured Clinical Interview for the DSM-IV Axis I Disorder; FSFI: Female sexual dysfunction index; PCASEE: Physical, cognitive, Affect, Social, economic, ego, quality of life

Female sexual dysfunction in undergraduate medical education: a survey of U.S. medical students.

Physicians often report low levels of confidence in diagnosing and treating female sexual dysfunction (FSD), which may stem from inadequate education and exposure to the topic. The study sought to determine the extent to which FSD is covered in undergraduate medical education and evaluate student comfort with the topic and familiarity with treatments. We created a novel, 50-question survey to be administered online to any current U.S. medical student. Obstetrician-gynecologist clerkship directors at 146 U.S. medical schools were contacted and asked to invite any current student at their school to participate. A link to the electronic REDCap (Research Electronic Data Capture) survey was distributed to eligible students via the clerkship directors. The survey collected data regarding (1) coverage of FSD and male sexual dysfunction (MSD) in preclinical and clinical curricula, (2) student self-ratings of comfort in hypothetical scenarios in which a patient exhibits symptoms of FSD or MSD, and (3) student familiarity with treatments for FSD and MSD. Outcomes included the proportion of students reporting that their school covered FSD/MSD in its preclinical/clinical curriculum, the mean comfort ratings for each of the FSD and MSD scenarios, and the proportion of students indicating knowledge of various FSD and MSD treatments. A smaller proportion of students (N = 236) reported receiving instruction in FSD (58.5%) compared with MSD (78.4%) in their preclinical curriculum (P < .001). Students' average self-ratings of comfort in the sexual dysfunction scenarios were significantly lower for patients with symptoms of FSD compared with MSD (P < .001). Students had higher average self-ratings of confidence in FSD scenarios if their intended specialty was obstetrician-gynecologist (P = .003), if their school included FSD in its clinical curriculum (P = .01), and if they had ever participated in the care of a patient with FSD (P = .006). There are important gaps in the coverage of FSD in undergraduate medical education that may be mitigated through improvements to curriculum and increased exposure to patients with FSD. This is the first study, to our knowledge, to directly survey medical students regarding their educational experience and comfort with FSD. Our study was limited by a small sample size, the use of a novel and nonvalidated questionnaire, and the potential for bias given our sampling method. Medical schools must work toward improving instruction in FSD for their students to address these disparities and improve students' comfort with the topic.

Female sexual medicine: an assessment of medical school curricula in a major United States city.

Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions. This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula. Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate. Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content. Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included. The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction. The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area. Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction.

The Effects of Herbal Medicines on Sexual Function and Sexual Satisfaction among Women: A Systematic Review and Meta-analysis

Context: Sexual dysfunction is one of the most common problems of women affecting their living standards. Concerns about the side effects of chemical drugs and the tendency to use complementary medicine have led to the introduction of herbal medicines as an alternative option to improve this disorder. Objectives: This study was planned to systematically investigate the effects of herbal medicines on sexual function and sexual satisfaction of women of reproductive age. Data Sources: All related articles published in English or Persian from 2000 to February 28, 2022, were reviewed. The international databases of Google Scholar, Science Direct, PubMed, Web of Science, Scopus, and Cochrane Library, and the national SID database were searched. Then, the articles were reviewed by two independent researchers. The data were combined using meta-analysis and the random effect model. Results: The findings of 12 studies entered into the meta-analysis showed that in the group of herbal medicines, the total score of female sexual function significantly improved (0.95; %95 CI: 0.803 - 1.097) (P = 0.001). Also, the sexual satisfaction score was higher in the group of herbal medicines (0.84; %95 CI: 0.476 - 1.21), which was significant (P = 0.001). Conclusions: Herbal medicines positively affect sexual function and sexual satisfaction of women of reproductive age and can be an effective and safe treatment for female sexual dysfunction (FSD). However, more studies with larger sample sizes on women of reproductive age are needed to achieve definitive conclusions.

The impact of cell-based therapy on female sexual dysfunction: a systematic review and meta-analysis.

Female sexual dysfunction (FSD) is a complex issue affecting women of all ages; it involves several overlapping body systems and profoundly affects quality of life. The use of cell-based therapy, such as mesenchymal stem cells, has recently been investigated as a potential treatment for FSD. This systematic review and meta-analysis aim to assess FSD outcomes following cell-based therapy. We evaluated peer-reviewed articles from multiple online databases through November 2022 to identify studies that used cell-based therapy and reported sexual function outcomes in women. We performed a meta-analysis using data pooled from 3 clinical trials at our institution: CRATUS (NCT02065245), ACESO (NCT02886884), and CERES (NCT03059355). All 3 trials collected data from the Sexual Quality of Life-Female (SQOL-F) questionnaire as an exploratory outcome. Existing literature on this topic is scarce. Five clinical studies and 1 animal study were included in the systematic review, and only 2 clinical studies were considered good quality: 1 reported significant SQOL-F improvement in women 6 months after cell therapy, and 1 reported posttherapy sexual satisfaction in all women. When individual patient data were pooled in a meta-analysis from 29 women across 3 trials at our institution, the SQOL-F was not significantly improved. Despite growing interest in cell-based therapy for women's sexual health, this important issue is understudied in the literature. The optimal route, source, and dose of cell therapy to produce clinically meaningful change have yet to be determined, and further research is needed in larger randomized placebo-controlled clinical trials.

(061) The State of Female Sexual Medicine in a Major US City: A Comprehensive Evaluation of Mmedical Education in Chicagoland

Abstract Introduction Sexual health is a critical aspect of overall health and well-being. While research shows that roughly one-third of patients in the United States (US) have sexual dysfunction, only half of US medical schools require formal sexual health instruction. With limited standardization, medical students and trainees have little to no training in how to approach a patient with sexual health concerns. This results in under-preparedness among physicians in addressing essential issues related to female sexual medicine (FSM). Therefore, we identified the need to determine which components of FSM are included in medical education. Objective This study examines current preclinical and clinical curricula from medical institutions in the Chicagoland area to evaluate the extent to which FSM is being included in medical education in this major US city. Methods Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as Obstetrics and Gynecology (OBGYN) clinical materials (i.e., syllabi, synchronous lecture materials, and supplemental resources) were collected from all seven medical schools, including six allopathic and one osteopathic institution, in the Chicagoland area. To standardize our needs assessment, we utilized previous literature to identify specific components of medical school content to evaluate. Upon reviewing each institution's educational materials, we assessed goals of each syllabus in terms of required content and evaluated materials for topic saturation. Results Curriculum materials were collected from seven (n=7) medical schools. In the preclinical assessment, 4/7 discussed clitoral anatomy, with 1/7 mentioning the corona, 2/7 mentioning the clitoral hood, and 4/7 mentioning the corpus spongiosum. In addition, 4/7 discussed the physiology of the female orgasm, 3/7 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3/7 included information on treatment for FSD, and 1/7 taught a genitourinary physical exam specific to assessing FSD. When assessing clinical materials, 5/7 institutions dedicate 6 weeks to the core OBGYN clerkship. When comparing the aims specified in the clerkship syllabi, 5/7 institutions included topics related to FSM. Of these, only one institution had corresponding required synchronous clerkship time dedicated to these topics as a one-hour long lecture. One other program offered supplemental case-based gynecology modules including topics such as vulvar and vaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not discussed. Furthermore, only one program offered training to third-year clinical students in comprehensive sexual history taking practices, including screening for female sexual dysfunction. The format for this was an optional online module for students to complete independently. Conclusions Our focused needs assessment of both allopathic and osteopathic medical schools in the Chicagoland area reveals inconsistencies in outlined institution-specific course goals and thus highlights the need for restructuring the medical school curricula to include topics related to FSM. Future directions of this work will include proposing curricular recommendations to these institutions with the goal of standardizing and enhancing medical student exposure to FSM topics. FSM is a critical domain that requires consistent representation in medical education to equip physicians to recognize and treat patients with sexual dysfunction. Disclosure No

(355) Sexually Speaking: How are Medical School Clinical Curricula Preparing Future Physicians?

Abstract Introduction Sexual health is an essential component of overall health and wellness. It has been demonstrated that roughly one-third of patients in the United States have sexual dysfunction defined as persistent, recurrent problems with sexual response, desire, orgasm, or pain that cause distress. Currently, only half of United States medical schools require formal sexual health instruction, which contributes to the under-preparedness physicians experience in addressing essential issues related to female sexual medicine (FSM). Previous work from our group revealed a need for restructuring pre-clinical medical school curricula as they pertain to FSM and female sexual dysfunction. Thus, a comprehensive education in medical schools’ clinical curricula covering FSM, including standardized screening for sexual dysfunction, assumes an important role. Objective This study focuses on educational content within the obstetrics and gynecology (OBGYN) core clerkships of medical schools to determine if and how FSM is taught to third-year medical students as they interact with patients. Methods OBGYN clerkship syllabi, synchronous lecture materials, and supplemental resources were collected from four medical schools, including three allopathic and one osteopathic institution, in the surrounding Chicago, Illinois area. To standardize our clinical curriculum needs assessment, we limited content review to lectures and resources provided directly from the institution to students during their OBGYN rotation. Upon review of each institution’s clerkship materials, we assessed the goals set forth in each syllabus in terms of lecture or online learning content required for completion by rotating students. Results Clerkship curriculum materials were collected from four (n=4) medical schools. Three of the four institutions dedicate 6 weeks to the core OBGYN clerkship, while one dedicates only 4 weeks. When comparing the specific aims and course content outlines in the rotation syllabi, 3 out of 4 institutions included topics on FSM or female sexual dysfunction. Of these, only one institution had corresponding synchronous clerkship time dedicated to these topics as a one-hour-long required lecture for students. Furthermore, only one program offered training to third-year clinical students in comprehensive sexual history-taking practices, including screening for female sexual dysfunction. The format in which this was fulfilled was through a recommended online module for interested students to complete independently. Conclusions Our focused needs assessment of both allopathic and osteopathic medical schools in the Chicagoland area reveals inconsistencies in the outlined institution-specific goals of their OBGYN clinical rotation and the content that was available and required for students to complete. A single one-hour lecture was included at only one institution specifically dedicated to the screening, diagnosis, and treatment of female sexual dysfunction. This same school was the only of the four to offer any training in screening for female sexual dysfunction, and this was not required, only recommended. Future work includes emphasizing FSM as crucial a domain for medical students to gain proficiency and confidence during clerkships, particularly in a didactic setting that can be utilized clinically on the wards. Disclosure No

(003) New Treatment Approach for Female Sexual Dysfunction by Transvaginal Shockwave Therapy (TVST)

Abstract Introduction Female Sexual Dysfunction (FSD) is a common condition of women especially following menopause. In recent years, energy-based devices (EBD), such as lasers and radio-frequencies, have been marketed for vaginal rejuvenation and FSD. Low-intensity shockwave therapy (LIST) has been introduced as a treatment for male erectile dysfunction and may hold promise for FSD. In women energy has to be delivered to the vaginal wall to manifest its tissue regenerative potential. In this pilot study, we evaluated a specially designed transvaginal probe, which is able to deliver shockwave energy to the vaginal wall and the external genitalia. Objective To evaluate the safety and therapeutic efficacy of LIST, when applied transvaginally for the treatment of FSD and incontinence. We call this approach transvaginal shockwave therapy (TVST). Methods The study was a single-arm, pilot study conducted between February-August 2021. Fifteen female patients aged 45-61 years (mean age: 52.7 years) were recruited and 78.6% of them were post-menopausal. All women presented with sexual dysfunction and 7 of them (46.7%) also reported urinary incontinence. Treatment was performed with the MoreNova system (Hikkonu Ltd., Israel), an electromagnetic low-intensity shockwave generator, using a novel transvaginal probe. Energy flow density was 0.09 mJoule/mm2 and intensity was gradually increased to the maximal tolerable level (1.6-1.8). Each session delivered 400 shockwaves to 6 predefined anatomical areas: the frontal vaginal wall (11 and 1 o' clock positions), the labia minora and majora (left, right). Patients underwent a total of 6 treatment sessions over the course of three weeks (2 per week). Statistical analysis was performed using student’s t-test (paired, one-tail, significance at p&amp;lt;0.05). Results Sexual dysfunction was assessed with the Female Sexual Function Index (FSFI) and incontinence with the ICIQ-UI Short-Form. Evaluations were performed at baseline and at 1 and 3 month post treatment. One patient aborted (for reasons unrelated to treatment) and was excluded from analysis. No patient complained of pain or discomfort during or after treatment and no side-effects were reported. Mean total FSFI score at baseline was 13.93, increased significantly to 22.66 at 1 month and slightly decreased to 20.88 at 3 months post treatment. All domains of the FSFI were significantly improved both at 1 and 3 month follow-ups compared to baseline. Percentage of patients achieving minimally clinically important differences (MCID) of the FSFI domains (Krychman et al, 2018) was also estimated. It was found that at 1 month follow-up more than 70% of patients achieved improvements exceeding the MCID in the pain, orgasm and lubrication FSFI domains. At 3 months, this significant improvement was sustained in the pain and orgasm domains. Mean ICIQ-UI was 3,53 at baseline and decreased to 3 at 3 months and 2.28 at 3 months post treatment. Conclusions There is a great need for new, effective and safe therapies for FSD. Quite often FSD is not reported by the patients and disregarded by physicians who are not involved in sexual medicine. Robust scientific evidence as to the efficacy of EBDs is also lacking. In our study, we found that TVST is safe and very well-tolerated by the patients. It improved FSD up to 3 months post treatment and this improvement was evident in all domains of the FSFI. There was also improvement in incontinence, as documented by the ICIQ-UI index. This observation surely warrants further investigation. Our data, although limited, underline the need for large scale, controlled studies ideally targeting different genito-urinary conditions. Disclosure Yes, this is sponsored by industry/sponsor: Direx Clarification Industry funding only - investigator initiated and executed study.

Female sexual health digital resources: women and health care providers need more options.

Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.

Female Sexual Dysfunction: A Primer for Primary Care Health Professionals.

Female sexual dysfunction (FSD) is common and associated with decreased quality of life, relationship satisfaction, and overall well-being. However, primary care practitioners report discomfort discussing, diagnosing, and treating FSD. We delivered two sessions on the approach to evaluation and treatment of FSD: a 60-minute didactic session and a 90-minute workshop. The intended audience was primary health care professionals who care for women. The workshop utilized interactive teaching methods including a large-group discussion, case-based discussions, debrief of an observed patient-physician discussion, and language drills to develop participants' knowledge and skills. Participants were surveyed about their practice patterns and attitudes toward FSD following the sessions on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). We collected 131 evaluations from a national Veterans Health Administration 60-minute didactic and four evaluations from the Society of General Internal Medicine Annual Meeting 90-minute workshop (response rates were 60% and 15%, respectively). One hundred thirty-five interdisciplinary trainees and practitioners from both audiences highly rated the workshop content (M = 4.1) and the overall session (M = 4.3). Didactic participants (n = 131) also reported high satisfaction (M = 4.5), increased knowledge and skills (M = 4.4), and improved interprofessional collaborative practice (M = 4.4) as a result of the training. Our evaluation shows high satisfaction following interactive multimodal sessions on FSD. These adaptable resources can be used in multiple educational settings (didactic and workshop) and for multiple time frames to teach about FSD.

PD26-05 FEMALE SEXUAL DYSFUNCTION: PRACTICE PATTERNS &amp; PATIENT EDUCATION AMONG SUFU AND AUGS MEMBERS

You have accessJournal of UrologyCME1 Apr 2023PD26-05 FEMALE SEXUAL DYSFUNCTION: PRACTICE PATTERNS & PATIENT EDUCATION AMONG SUFU AND AUGS MEMBERS Poone Shoureshi, Alexandra Dubinskaya, Catherine Bresee, Mickey Karram, and Karyn S. Eilber Poone ShoureshiPoone Shoureshi More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Mickey KarramMickey Karram More articles by this author , and Karyn S. EilberKaryn S. Eilber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The evaluation and treatment of female sexual dysfunction (FSD) has been slow to progress. In 2004, the American Urogynecology Society (AUGS) surveyed its members to assess practice patterns for FSD. The objective of this study was to administer a similar survey to current members of AUGS and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) to evaluate existing practice patterns. METHODS: An electronic survey based on a prior survey administered to AUGS members in 2004 was distributed to current SUFU and AUGS members. The results were compared. RESULTS: 187 physicians responded. The majority were female (75%). Respondent experience was<5 years in practice (25%), 5-10 years (20%), 11-20 years (17%), >20 years (22%), or currently in fellowship (16%). Fifty-four percent were at an academic or university-based practice. Physicians assessed FSD by asking about sexual activity (89%), dyspareunia (89%), arousal (33%), libido (29%), and orgasm (21%), while few reported using validated questionnaires (19%). Most physicians (54%) responded they perceived the overall incidence of FSD ranged 21-50%. Screening practices and barriers are listed in Table 1 and compared to the responses from AUGS members in 2004. The majority of current responders had post-residency training (84% vs. 59% in 2004, p<0.001). 20% of current members consider FSD screening to be extremely important versus 9% in 2004 (p=0.002). Most common reason for not screening was time constraints. Current practitioners also report not screening because they do not know how/what to ask, whereas in 2004 physicians were more unsure about therapeutic options (p<0.001). In regards to post residency training, 52% were less than satisfied, significantly improved compared to 71% in 2004 (p<0.001). Eighty-seven percent of current AUGS/SUFU members would feel comfortable referring patients to an interactive phone application about FSD. CONCLUSIONS: Screening patterns and barriers to treatment of FSD have remained relatively unchanged over the last 18 years, with the most common barrier being time constraints. Many FPMRS/urogynecology trainees continue to feel unsatisfied with FSD training. In the future, phone applications may be a good resource when practitioners are uncomfortable or have a lack of time to discuss FSD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e736 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Poone Shoureshi More articles by this author Alexandra Dubinskaya More articles by this author Catherine Bresee More articles by this author Mickey Karram More articles by this author Karyn S. Eilber More articles by this author Expand All Advertisement PDF downloadLoading ...