{"id":101,"date":"2020-08-12T19:48:55","date_gmt":"2020-08-12T19:48:55","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=101"},"modified":"2021-05-09T20:55:14","modified_gmt":"2021-05-09T20:55:14","slug":"human-sexuality","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/human-sexuality\/","title":{"rendered":"56. Human Sexuality"},"content":{"rendered":"<p><strong>Part 1: Counseling Patients About Sexuality<\/strong><\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/O5DJTf4s-Uw\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 11:58<\/p>\n<input type='hidden' bg_collapse_expand='69e9b550e90fd5037239296' value='69e9b550e90fd5037239296'><input type='hidden' id='bg-show-more-text-69e9b550e90fd5037239296' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b550e90fd5037239296' value='Hide Transcript'><button id='bg-showmore-action-69e9b550e90fd5037239296' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b550e90fd5037239296' ><\/p>\n<p>00:00<br \/>\nwelcome to the APGO sexual health<br \/>\n00:02<br \/>\nvideo series in this first video we will<br \/>\n00:05<br \/>\nreview how to counsel your patients<br \/>\n00:07<br \/>\nabout issues pertaining to sexuality and<br \/>\n00:09<br \/>\nsexual health sexual health is important<br \/>\n00:13<br \/>\nto a woman&#8217;s overall health and<br \/>\n00:15<br \/>\nwell-being and the American College of<br \/>\n00:18<br \/>\nObstetricians and Gynaecologists ACOG<br \/>\n00:21<br \/>\nrecommends that sexual health be<br \/>\n00:23<br \/>\nincorporated into every well-woman visit<br \/>\n00:26<br \/>\nacross the lifespan<br \/>\n00:29<br \/>\ndata suggests that most women want<br \/>\n00:32<br \/>\nproviders to bring up the topic of<br \/>\n00:34<br \/>\nsexuality during their healthcare visits<br \/>\n00:37<br \/>\ndiscussion of sexual health can prevent<br \/>\n00:39<br \/>\nunnecessary sexual health related<br \/>\n00:41<br \/>\noutcomes such as HIV and other sexually<br \/>\n00:44<br \/>\ntransmitted infections unintended<br \/>\n00:47<br \/>\npregnancies and sexual assaults it can<br \/>\n00:52<br \/>\nalso uncover sexual problems gynecologic<br \/>\n00:55<br \/>\nand medical conditions and sexual<br \/>\n00:58<br \/>\ndysfunctions<br \/>\n01:01<br \/>\nalthough female sexual dysfunction is<br \/>\n01:04<br \/>\ncommon estimated to affect 43% of women<br \/>\n01:07<br \/>\nmost OBGYNs don&#8217;t spend much time on<br \/>\n01:10<br \/>\nsexual health a 2012 survey found that<br \/>\n01:15<br \/>\nalthough 63% of practicing OBGYNs<br \/>\n01:18<br \/>\nroutinely asked their female patients<br \/>\n01:19<br \/>\nabout the types of sexual activities<br \/>\n01:21<br \/>\nthey engage in they didn&#8217;t usually ask<br \/>\n01:24<br \/>\nabout other sexual issues such as sexual<br \/>\n01:27<br \/>\ndysfunction as a clinician you must be<br \/>\n01:31<br \/>\nopen to the idea that your patient may<br \/>\n01:33<br \/>\nbe heterosexual lesbian bisexual or<br \/>\n01:38<br \/>\nsexually fluid she may not be sexually<br \/>\n01:42<br \/>\nactive or she may be active with one or<br \/>\n01:45<br \/>\nmany partners she also may have other<br \/>\n01:48<br \/>\nthoughts about her sexual identity do<br \/>\n01:52<br \/>\nnot assume that all women are in stable<br \/>\n01:54<br \/>\nloving relationships monogamous using<br \/>\n01:58<br \/>\ncontraception if they are of<br \/>\n02:00<br \/>\nreproductive age and sexually active and<br \/>\n02:03<br \/>\nare not being abused or coerced into<br \/>\n02:06<br \/>\nsexual activity by their partner this is<br \/>\n02:08<br \/>\nwhy it is so important to proactively<br \/>\n02:10<br \/>\nask your patients about sexuality and<br \/>\n02:12<br \/>\nsexual health there are a number of<br \/>\n02:16<br \/>\nidentified barriers to healthcare<br \/>\n02:18<br \/>\nprovider patient discussions about<br \/>\n02:20<br \/>\nsexual health and history one of the<br \/>\n02:23<br \/>\nmost common barriers is provider<br \/>\n02:25<br \/>\ndiscomfort in discussing sexually<br \/>\n02:27<br \/>\nrelated topics it is important to<br \/>\n02:30<br \/>\nreflect upon your personal comfort level<br \/>\n02:33<br \/>\nand identify your biases about sexuality<br \/>\n02:35<br \/>\nto reduce your discomfort<br \/>\n02:38<br \/>\nby routinely engaging in sexuality<br \/>\n02:41<br \/>\ndiscussions with your patients you will<br \/>\n02:43<br \/>\nincrease your confidence level in this<br \/>\n02:45<br \/>\narea just as you would with any other<br \/>\n02:47<br \/>\nskill other provider barriers are the<br \/>\n02:52<br \/>\nfear that screening will be too<br \/>\n02:53<br \/>\ntime-consuming for a busy clinical<br \/>\n02:55<br \/>\npractice and the mistaken belief that<br \/>\n02:57<br \/>\nthere are no or few safe yet effective<br \/>\n03:00<br \/>\ntreatment options available another<br \/>\n03:03<br \/>\nbarrier is the notion that you have<br \/>\n03:05<br \/>\nfailed a patient if you have to refer<br \/>\n03:07<br \/>\nher to a specialist in fact you may help<br \/>\n03:10<br \/>\nher more by developing a referral<br \/>\n03:12<br \/>\nnetwork of specialized providers who<br \/>\n03:14<br \/>\nhave the skills to treat her to overcome<br \/>\n03:19<br \/>\nprovider barriers consider scheduling<br \/>\n03:22<br \/>\nvisits specifically for the purpose of<br \/>\n03:24<br \/>\nfocusing on sexual health issues with<br \/>\n03:26<br \/>\npatients particularly if a patient<br \/>\n03:29<br \/>\nexpresses a sexual concern it is also<br \/>\n03:33<br \/>\nhelpful to offer and discuss handouts<br \/>\n03:35<br \/>\nand educational website information as<br \/>\n03:37<br \/>\nwell as provide other resources on<br \/>\n03:40<br \/>\nsexuality topics to patients<br \/>\n03:43<br \/>\nspecific practical conversation<br \/>\n03:46<br \/>\ntechniques for overcoming provider and<br \/>\n03:48<br \/>\npatient barriers include asking<br \/>\n03:50<br \/>\nopen-ended questions to solicit more<br \/>\n03:53<br \/>\nrevealing answers beyond yes or no<br \/>\n03:56<br \/>\nexamples include what sexual concerns<br \/>\n03:59<br \/>\nwould you like to talk about instead of<br \/>\n04:02<br \/>\ndo you have any sexual concerns you want<br \/>\n04:05<br \/>\nto discuss or how does your sexual<br \/>\n04:08<br \/>\nconcern affect your relationship with<br \/>\n04:10<br \/>\nyour partner instead of does your sexual<br \/>\n04:14<br \/>\nconcern affect your relationship with<br \/>\n04:15<br \/>\nyour partner you may also consider<br \/>\n04:19<br \/>\npointed detailed questions thereafter to<br \/>\n04:22<br \/>\nbetter characterize our sexual problem<br \/>\n04:25<br \/>\nfollow a pattern of asking an open-ended<br \/>\n04:28<br \/>\nquestion educating and then asking<br \/>\n04:32<br \/>\nanother question<br \/>\n04:35<br \/>\nother effective communication techniques<br \/>\n04:38<br \/>\ninclude speaking and neutral and<br \/>\n04:40<br \/>\ninclusive terms meaning you are<br \/>\n04:42<br \/>\nnon-judgmental and include all forms of<br \/>\n04:45<br \/>\npossible sexual expression heterosexual<br \/>\n04:48<br \/>\nlesbian etc for instance use the term<br \/>\n04:53<br \/>\npartner instead of husband or boyfriend<br \/>\n04:56<br \/>\nif you are uncomfortable you should<br \/>\n05:00<br \/>\nstrive not to over react this requires<br \/>\n05:03<br \/>\nthat you take care and what you say and<br \/>\n05:05<br \/>\nin how you communicate non-verbally in<br \/>\n05:08<br \/>\nterms of your body language and posture<br \/>\n05:11<br \/>\nalso be aware of the effective use of<br \/>\n05:13<br \/>\nsilence as it may take patients some<br \/>\n05:17<br \/>\ntime to reveal awkward but salient<br \/>\n05:19<br \/>\ninformation about their sexuality<br \/>\n05:22<br \/>\nin order to effectively counsel and<br \/>\n05:25<br \/>\neducate patients it is important that<br \/>\n05:27<br \/>\nyou understand the female sexual<br \/>\n05:29<br \/>\nresponse the traditional model of female<br \/>\n05:33<br \/>\nsexuality developed by William masters<br \/>\n05:35<br \/>\nin Virginia Johnson suggested that like<br \/>\n05:38<br \/>\nin men arousal and sexual desire<br \/>\n05:40<br \/>\nproceeded in a linear manner to plateau<br \/>\n05:43<br \/>\norgasm and resolution it should be noted<br \/>\n05:48<br \/>\nthat women can also experience<br \/>\n05:49<br \/>\nresolution without orgasm Kaplan added<br \/>\n05:53<br \/>\nthe concept of desire to that model but<br \/>\n05:57<br \/>\nit&#8217;s clear that a woman&#8217;s sexual<br \/>\n05:58<br \/>\nresponse is much more dynamic and<br \/>\n06:00<br \/>\nmultifactorial than a straight line<br \/>\n06:02<br \/>\nprogression there are now multiple<br \/>\n06:04<br \/>\ndifferent models and theories and there<br \/>\n06:06<br \/>\nis no one accepted model<br \/>\n06:10<br \/>\ndr. rosemary Bosson of the Center for<br \/>\n06:13<br \/>\nsexual medicine at Vancouver General<br \/>\n06:15<br \/>\nHospital has developed a circular model<br \/>\n06:18<br \/>\nof female sexuality that incorporated<br \/>\n06:20<br \/>\nemotional components this model suggests<br \/>\n06:24<br \/>\nthat female sexuality is multifactorial<br \/>\n06:27<br \/>\nand heterogeneous and that the desire<br \/>\n06:30<br \/>\nfor sexual activity may be motivated<br \/>\n06:32<br \/>\nmore by a desire for emotional intimacy<br \/>\n06:34<br \/>\nthan for sexual release to put it<br \/>\n06:38<br \/>\nanother way<br \/>\n06:39<br \/>\nthis model demonstrates that women can<br \/>\n06:42<br \/>\nhave a reactive libido they may start<br \/>\n06:45<br \/>\noff in a sexually neutral frame of mind<br \/>\n06:46<br \/>\nbut become interested in sex if their<br \/>\n06:49<br \/>\npartner approaches them they may also<br \/>\n06:52<br \/>\nexperience arousal before desire many<br \/>\n06:56<br \/>\nphysical psychological societal cultural<br \/>\n07:00<br \/>\nand interpersonal factors impact sexual<br \/>\n07:03<br \/>\nhealth including changes in sexual<br \/>\n07:06<br \/>\nfunction throughout the lifecycle life<br \/>\n07:10<br \/>\ntransitions such as divorce or death of<br \/>\n07:13<br \/>\na partner chronic or acute illness<br \/>\n07:16<br \/>\nincluding gynecologic disorders and<br \/>\n07:18<br \/>\nlong-term disability medications<br \/>\n07:24<br \/>\nsexually transmitted infections or sti&#8217;s<br \/>\n07:28<br \/>\nviolence and trauma stigmas and<br \/>\n07:32<br \/>\nreligious beliefs use of tobacco drugs<br \/>\n07:36<br \/>\nand alcohol work life family and<br \/>\n07:40<br \/>\nfinancial stress changes in sexual<br \/>\n07:44<br \/>\nself-esteem including body image and the<br \/>\n07:46<br \/>\nperception of oneself as a sexual being<br \/>\n07:50<br \/>\nalthough it is acknowledged that sexual<br \/>\n07:53<br \/>\nproblems are common the definition of<br \/>\n07:56<br \/>\nsexual dysfunction hinges on whether or<br \/>\n07:59<br \/>\nnot it causes quote clinically<br \/>\n08:02<br \/>\nsignificant distress in the individual<br \/>\n08:06<br \/>\nin other words a woman is unable to<br \/>\n08:09<br \/>\nparticipate in sexual activity as she<br \/>\n08:12<br \/>\nwishes without distress treatment for a<br \/>\n08:16<br \/>\nsexual problem may not be necessary<br \/>\n08:20<br \/>\nstatistically speaking 43% of American<br \/>\n08:23<br \/>\nwomen report a sexual problem but sexual<br \/>\n08:27<br \/>\ndysfunction causing distress is less<br \/>\n08:29<br \/>\ncommon at around twenty two point eight<br \/>\n08:31<br \/>\npercent newer definitions of sexual<br \/>\n08:35<br \/>\ndysfunctions released with the<br \/>\n08:37<br \/>\nDiagnostic and Statistical Manual<br \/>\n08:38<br \/>\nEdition 5 in 2013 specify that a problem<br \/>\n08:43<br \/>\nshould be present for a minimum duration<br \/>\n08:45<br \/>\nof six months to be diagnosed as a<br \/>\n08:48<br \/>\nsexual dysfunction the provider is also<br \/>\n08:52<br \/>\nadvised to rule out other potential<br \/>\n08:54<br \/>\nreasons for the sexual problem again<br \/>\n08:57<br \/>\nmany problems although distressing may<br \/>\n09:01<br \/>\nbe transient and may not meet the<br \/>\n09:03<br \/>\nofficial definition for a sexual<br \/>\n09:05<br \/>\ndysfunction prior to the release of the<br \/>\n09:08<br \/>\ndsm-5 OBGYNs relied on the DSM fourth<br \/>\n09:12<br \/>\nedition text revision which had four<br \/>\n09:14<br \/>\ncategories of sexual dysfunction for<br \/>\n09:16<br \/>\nwomen some providers find these older<br \/>\n09:20<br \/>\ncategories more clinically useful than<br \/>\n09:22<br \/>\nthe dsm-5 categories and terms used in<br \/>\n09:26<br \/>\nthe DSM 40 are such as hypoactive sexual<br \/>\n09:29<br \/>\ndesire disorder or HSDD are still used<br \/>\n09:33<br \/>\ntoday in the dsm-5 patterns of female<br \/>\n09:37<br \/>\nsexual dysfunction focus on chronic<br \/>\n09:39<br \/>\nsymptoms involving interest arousal<br \/>\n09:42<br \/>\norgasm and pain female sexual<br \/>\n09:47<br \/>\ndysfunctions are interrelated and<br \/>\n09:49<br \/>\noverlapping and the presenting<br \/>\n09:51<br \/>\ndysfunction may not be the primary<br \/>\n09:53<br \/>\ndysfunction for example decreased<br \/>\n09:58<br \/>\narousal can lead to a lack of vaginal<br \/>\n10:00<br \/>\nlubrication and thus pain with<br \/>\n10:02<br \/>\nintercourse<br \/>\n10:03<br \/>\nwhich can decrease desire alternatively<br \/>\n10:07<br \/>\ndecrease desire can lead to decreased<br \/>\n10:09<br \/>\narousal which can lead to pain which is<br \/>\n10:12<br \/>\nthe presenting dysfunction in the next<br \/>\n10:16<br \/>\nfew slides we will review the dsm-5<br \/>\n10:18<br \/>\ncategories low desire with distress is<br \/>\n10:23<br \/>\nthe most frequent female sexual<br \/>\n10:25<br \/>\ndysfunction with 8 to 10 percent of<br \/>\n10:28<br \/>\nwomen meeting the diagnostic criteria<br \/>\n10:32<br \/>\nfemale sexual interest arousal disorder<br \/>\n10:35<br \/>\nis defined as lack of or significantly<br \/>\n10:38<br \/>\nreduced sexual interest arousal in 3 of<br \/>\n10:42<br \/>\nthe following aspects<br \/>\n10:50<br \/>\nfemale orgasmic disorder is the presence<br \/>\n10:53<br \/>\nof either of the following 75 to 100<br \/>\n10:57<br \/>\npercent of the time during sexual<br \/>\n10:59<br \/>\nactivity<br \/>\n11:01<br \/>\njeanna doe pelvic pain penetration<br \/>\n11:04<br \/>\ndisorder is defined by persistent or<br \/>\n11:07<br \/>\nrecurrent difficulties with one or more<br \/>\n11:10<br \/>\nof the following<br \/>\n11:16<br \/>\nfor more information on counseling<br \/>\n11:18<br \/>\nsexual health response cycles and sexual<br \/>\n11:22<br \/>\nhealth dysfunctions please refer to the<br \/>\n11:24<br \/>\nreferences at the end of this video<br \/>\n11:28<br \/>\ncontinue on to the next video in this<br \/>\n11:30<br \/>\nseries to learn more about how to take a<br \/>\n11:32<br \/>\nsexual history and assess and treat<br \/>\n11:34<br \/>\nfemale sexual dysfunctions<br \/>\n11:44<br \/>\nyou<\/p>\n<p><\/div>\n<hr \/>\n<p><strong>Part II: Treatment for Female Sexual Dysfunction<\/strong><\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/y3ONVrFemWY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 12:51<\/p>\n<input type='hidden' bg_collapse_expand='69e9b550e9b3b4037347195' value='69e9b550e9b3b4037347195'><input type='hidden' id='bg-show-more-text-69e9b550e9b3b4037347195' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b550e9b3b4037347195' value='Hide Transcript'><button id='bg-showmore-action-69e9b550e9b3b4037347195' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b550e9b3b4037347195' ><\/p>\n<p>00:00<br \/>\nwelcome to the second video in the APGO<br \/>\n00:03<br \/>\nsexual health video series this video<br \/>\n00:05<br \/>\nfocuses on how to complete a<br \/>\n00:07<br \/>\ncomprehensive sexual history and perform<br \/>\n00:09<br \/>\na directed physical exam for sexual<br \/>\n00:11<br \/>\nconcerns it will also briefly address<br \/>\n00:13<br \/>\ntreatment strategies at the end of this<br \/>\n00:16<br \/>\nvideo or a list of resources mentioned<br \/>\n00:18<br \/>\nin this series incorporating a sexual<br \/>\n00:22<br \/>\nhistory into well woman care is a way to<br \/>\n00:24<br \/>\nincrease your comfort level with<br \/>\n00:26<br \/>\ndiscussing sexual health with your<br \/>\n00:27<br \/>\npatients as well as identifying and<br \/>\n00:29<br \/>\ntreating sexual problems or dysfunctions<br \/>\n00:31<br \/>\nearly the sexual history can be included<br \/>\n00:34<br \/>\nin a review of systems in the section on<br \/>\n00:37<br \/>\nsocial history or in response to answers<br \/>\n00:40<br \/>\non a waiting room questionnaire ideally<br \/>\n00:43<br \/>\nit should be conducted before the<br \/>\n00:44<br \/>\nphysical exam while a woman is fully<br \/>\n00:46<br \/>\nclothed to reduce her feelings of<br \/>\n00:48<br \/>\nanxiety and vulnerability<br \/>\n00:52<br \/>\nthis algorithm from the National<br \/>\n00:54<br \/>\nCoalition for sexual health could be<br \/>\n00:55<br \/>\nused as a starting point for the<br \/>\n00:57<br \/>\nconversation however a clinician should<br \/>\n00:59<br \/>\ntailor questioning to his or her<br \/>\n01:01<br \/>\npractice style and incorporate<br \/>\n01:03<br \/>\nopen-ended questions if the patient has<br \/>\n01:05<br \/>\na specific complaint then more specific<br \/>\n01:08<br \/>\nquestions may be asked to better<br \/>\n01:09<br \/>\nunderstand her specific sexual concern<br \/>\n01:11<br \/>\nif needed a separate appointment can be<br \/>\n01:14<br \/>\nmade to discuss sexual concerns the ACOG<br \/>\n01:18<br \/>\nopinion report number 706 titled sexual<br \/>\n01:21<br \/>\nhealth has a more detailed list of<br \/>\n01:23<br \/>\nquestions to ask during the sexual<br \/>\n01:24<br \/>\nhistory including questions on the 4ps<br \/>\n01:28<br \/>\npartners practices protection from s-cis<br \/>\n01:31<br \/>\nand past history of esti is physical<br \/>\n01:37<br \/>\nexamination should be performed as<br \/>\n01:39<br \/>\nnecessary to evaluate for sexual<br \/>\n01:41<br \/>\ndisorders this examination is usually<br \/>\n01:44<br \/>\nbased on a patient&#8217;s complaints and<br \/>\n01:45<br \/>\nreproductive stage of life for instance<br \/>\n01:48<br \/>\nin a mature woman complaining a vaginal<br \/>\n01:51<br \/>\ndryness with dyspareunia pain during<br \/>\n01:53<br \/>\nintercourse you would perform a genital<br \/>\n01:55<br \/>\npelvic assessment to evaluate for<br \/>\n01:57<br \/>\ngenitourinary syndrome of menopause in a<br \/>\n02:00<br \/>\nyounger woman complaining of discharge<br \/>\n02:01<br \/>\nin dyspareunia genital infections should<br \/>\n02:04<br \/>\nbe ruled out in cases of dyspareunia the<br \/>\n02:07<br \/>\ngenital exam should try to reproduce the<br \/>\n02:09<br \/>\npain a detailed physical examination<br \/>\n02:12<br \/>\nshould not be dismissed if the patient<br \/>\n02:14<br \/>\nis complaining of other symptoms<br \/>\n02:15<br \/>\nfor instance if thyroid symptoms are<br \/>\n02:18<br \/>\nelicited during the history and may be<br \/>\n02:20<br \/>\nassociated with decreased libido a<br \/>\n02:21<br \/>\ndetailed thyroid evaluation should be<br \/>\n02:24<br \/>\nperformed<br \/>\n02:27<br \/>\nconsult this table from Kingsburg and<br \/>\n02:29<br \/>\njanata for a more comprehensive<br \/>\n02:30<br \/>\ndescription of the euro gynecologic exam<br \/>\n02:33<br \/>\nfor conditions that can impair sexual<br \/>\n02:35<br \/>\nfunction and assist in diagnosis<br \/>\n02:37<br \/>\nreferral for a full evaluation by a more<br \/>\n02:40<br \/>\nexperienced clinician as an option if<br \/>\n02:42<br \/>\nyou do not feel you have the skills to<br \/>\n02:43<br \/>\ndo a more advanced physical exam for<br \/>\n02:45<br \/>\nsexual health issues a number of<br \/>\n02:49<br \/>\ninterventions can be employed for all<br \/>\n02:51<br \/>\nforms of female sexual dysfunction we<br \/>\n02:54<br \/>\nwill now review global interventions and<br \/>\n02:56<br \/>\ndisorder specific interventions it can<br \/>\n03:00<br \/>\nbe useful to remember the placet model<br \/>\n03:02<br \/>\nwhen discussing sexual health treatment<br \/>\n03:04<br \/>\nwith patients it consists of giving<br \/>\n03:07<br \/>\npermission to raise sexual issues to use<br \/>\n03:09<br \/>\nsuggestions and try new things<br \/>\n03:12<br \/>\ngiving limited information about a<br \/>\n03:14<br \/>\nsexual concern including clarifying<br \/>\n03:17<br \/>\nmisinformation dispelling myths and<br \/>\n03:19<br \/>\nproviding limited factual information<br \/>\n03:22<br \/>\nmaking specific suggestions about the<br \/>\n03:25<br \/>\nproblem in question and offering or<br \/>\n03:29<br \/>\nreferring the patient for intensive<br \/>\n03:30<br \/>\ntherapy for the problem Global<br \/>\n03:35<br \/>\ninterventions for all dysfunctions<br \/>\n03:37<br \/>\ninclude ruling out underlying medical<br \/>\n03:39<br \/>\nillness or anatomical pathology or<br \/>\n03:41<br \/>\nconditions as well as medications that<br \/>\n03:43<br \/>\nmay have direct sexual side-effects you<br \/>\n03:46<br \/>\ncan and should also educate the patient<br \/>\n03:48<br \/>\nabout the specific sexual dysfunction<br \/>\n03:50<br \/>\nand provide appropriate literature or<br \/>\n03:52<br \/>\nhandouts for her to review at her<br \/>\n03:53<br \/>\ndiscretion<br \/>\n03:54<br \/>\nyou may also prescribe medications for<br \/>\n03:57<br \/>\ncertain underlying sexual medical issues<br \/>\n04:01<br \/>\nstructured sexual tasks such as<br \/>\n04:03<br \/>\nmasturbation self-stimulation using a<br \/>\n04:05<br \/>\nvibrator as well as simple sense 8 focus<br \/>\n04:08<br \/>\nand mindfulness exercises may be helpful<br \/>\n04:10<br \/>\nrecommendations these are typically<br \/>\n04:12<br \/>\nincluded in marital and sex therapy<br \/>\n04:14<br \/>\ncounseling sessions under a form of<br \/>\n04:16<br \/>\ncognitive behavioral therapy sense8<br \/>\n04:19<br \/>\nfocus exercises eliminate orgasm as the<br \/>\n04:22<br \/>\ngoal of sexual encounters and instead<br \/>\n04:24<br \/>\nfocus on body awareness and the types of<br \/>\n04:26<br \/>\nstimulation that makes a woman feel good<br \/>\n04:28<br \/>\nthese exercises also initially avoid any<br \/>\n04:31<br \/>\nerotic stimulation and promote good<br \/>\n04:34<br \/>\ncommunication with a partner mindfulness<br \/>\n04:37<br \/>\nis a technique to help a woman focus on<br \/>\n04:39<br \/>\nwhat is happening and what she is<br \/>\n04:40<br \/>\nfeeling in the present moment and not<br \/>\n04:42<br \/>\njudge her experience in the next section<br \/>\n04:46<br \/>\nof this video we will review disorder<br \/>\n04:48<br \/>\nspecific interventions the dsm-5<br \/>\n04:52<br \/>\ncombines desire and arousal disorders<br \/>\n04:54<br \/>\nhere we will review them separately as<br \/>\n04:57<br \/>\nlack of or low desire with distress is<br \/>\n04:59<br \/>\nthe most common female sexual<br \/>\n05:00<br \/>\ndysfunction and the term hypoactive<br \/>\n05:03<br \/>\nsexual desire disorder or HSDD is still<br \/>\n05:06<br \/>\ncommonly used one intervention for lack<br \/>\n05:09<br \/>\nof desire is to educate patients that<br \/>\n05:11<br \/>\ntheir experience is normal and that<br \/>\n05:13<br \/>\nthere are safe effective treatments<br \/>\n05:14<br \/>\navailable the knowledge that a woman may<br \/>\n05:18<br \/>\nnot feel spontaneous desire or may be<br \/>\n05:20<br \/>\nmotivated more by a desire for emotional<br \/>\n05:22<br \/>\nintimacy with her partner than for<br \/>\n05:23<br \/>\nsexual release may be all that is needed<br \/>\n05:26<br \/>\nto improve her sex life books and other<br \/>\n05:29<br \/>\nresources may also be helpful<br \/>\n05:32<br \/>\nprescribing medication for lack of<br \/>\n05:34<br \/>\ndesire is another option there is<br \/>\n05:36<br \/>\nemerging data on the value of medication<br \/>\n05:39<br \/>\nand a woman should be offered medication<br \/>\n05:41<br \/>\nwithout judgment as part of her<br \/>\n05:42<br \/>\ntreatment paradigm flibanserin is<br \/>\n05:47<br \/>\ncurrently the only fda approved drug for<br \/>\n05:49<br \/>\ngeneralized acquired HSDD and is<br \/>\n05:51<br \/>\nindicated for pre menopausal women it is<br \/>\n05:54<br \/>\na non hormonal agent that affects<br \/>\n05:55<br \/>\nneurotransmitters that influence sexual<br \/>\n05:57<br \/>\ndesire clinical data suggests that<br \/>\n06:00<br \/>\napproximately half of women with HSDD<br \/>\n06:02<br \/>\nmay respond to flibanserin adverse<br \/>\n06:05<br \/>\nevents include dizziness somnolence and<br \/>\n06:07<br \/>\nnausea the risk of hypotension and<br \/>\n06:10<br \/>\nsyncope increase when flibanserin is<br \/>\n06:11<br \/>\ntaken with certain other drugs or<br \/>\n06:13<br \/>\nalcohol<br \/>\n06:14<br \/>\nwomen should discontinue drinking<br \/>\n06:15<br \/>\nalcohol at least two hours before taking<br \/>\n06:18<br \/>\nflibanserin at bedtime<br \/>\n06:19<br \/>\nthe drug is only available under a risk<br \/>\n06:22<br \/>\nevaluation and mitigation strategy REMS<br \/>\n06:24<br \/>\nand clinicians must be certified to<br \/>\n06:26<br \/>\nprescribe it testosterone therapy is<br \/>\n06:29<br \/>\nanother option for some women with HSDD<br \/>\n06:31<br \/>\nbut currently is not fda-approved for<br \/>\n06:33<br \/>\ntreatment in either pre or<br \/>\n06:34<br \/>\npostmenopausal women interventions for<br \/>\n06:39<br \/>\narousal issues include educating a woman<br \/>\n06:41<br \/>\nabout the mechanics of arousal and<br \/>\n06:43<br \/>\ngenital engorgement and conducting an<br \/>\n06:45<br \/>\ninstructional pelvic examination to help<br \/>\n06:47<br \/>\na woman identify the clitoris clinicians<br \/>\n06:51<br \/>\ncan also recommend reading materials and<br \/>\n06:52<br \/>\nresources mindfulness exercises directed<br \/>\n06:56<br \/>\nmasturbation to help a woman identify<br \/>\n06:57<br \/>\nwhat kinds of stimulation arouse her and<br \/>\n06:59<br \/>\nsense8 focus exercises increasing<br \/>\n07:04<br \/>\nstimulation with longer directed<br \/>\n07:05<br \/>\nforeplay or use of a vibrator during<br \/>\n07:07<br \/>\npartnered sexual encounters may also be<br \/>\n07:09<br \/>\nsuggested another simple practical<br \/>\n07:13<br \/>\nrecommendation is use of<br \/>\n07:14<br \/>\nover-the-counter topical arousal creams<br \/>\n07:16<br \/>\nthese creams which are wrapped into the<br \/>\n07:19<br \/>\ngenital area are reported to increase<br \/>\n07:21<br \/>\nblood flow to the clitoris and genitals<br \/>\n07:22<br \/>\nand may result in improved genital and<br \/>\n07:24<br \/>\ngorge mint although there is limited<br \/>\n07:27<br \/>\ndata on these products they can be used<br \/>\n07:29<br \/>\nsuccessfully in some women skin<br \/>\n07:32<br \/>\nirritation may develop in some so an<br \/>\n07:35<br \/>\ninitial trial with a small amount even<br \/>\n07:37<br \/>\nin a non genital location as prudent<br \/>\n07:40<br \/>\nwomen with female orgasmic disorder may<br \/>\n07:43<br \/>\nlack body awareness about how to have an<br \/>\n07:45<br \/>\norgasm or may have misperceptions that<br \/>\n07:47<br \/>\nthey should be having vaginal orgasms<br \/>\n07:49<br \/>\nduring intercourse or simultaneous<br \/>\n07:52<br \/>\norgasms with their partner both in fact<br \/>\n07:54<br \/>\noccur rarely they may benefit from basic<br \/>\n07:58<br \/>\nsex education accompanied by an<br \/>\n08:00<br \/>\ninstructional pelvic exam to identify<br \/>\n08:02<br \/>\nthe clitoris reading materials and<br \/>\n08:05<br \/>\nresources can be helpful to increase<br \/>\n08:07<br \/>\nunderstanding of anatomy and dispel<br \/>\n08:08<br \/>\nmyths clinicians should discuss methods<br \/>\n08:11<br \/>\nof increased stimulation such as<br \/>\n08:13<br \/>\nvibrators as well as where and how to<br \/>\n08:16<br \/>\nobtain them this is an example of using<br \/>\n08:19<br \/>\nthe P implicit permission to try new<br \/>\n08:22<br \/>\nthings<br \/>\n08:25<br \/>\nmany women have pelvic floor problems<br \/>\n08:27<br \/>\nsuch as laxity prolapse or poor muscle<br \/>\n08:31<br \/>\ncontraction for these women instructions<br \/>\n08:34<br \/>\non how to perform pelvic floor exercises<br \/>\n08:35<br \/>\noften referred to as kegels can help<br \/>\n08:38<br \/>\nstrengthen and improve control of these<br \/>\n08:40<br \/>\nmuscles in other cases referral to a<br \/>\n08:43<br \/>\ngenital pelvic floor physical therapists<br \/>\n08:45<br \/>\nfor therapy may be appropriate<br \/>\n08:47<br \/>\nof course the clinician should evaluate<br \/>\n08:49<br \/>\nall medications the patient is taking<br \/>\n08:51<br \/>\nthat may be inhibiting her orgasmic<br \/>\n08:53<br \/>\nresponse and inquire about relationship<br \/>\n08:56<br \/>\npsychosexual issues that may be<br \/>\n08:57<br \/>\nimpacting her sexual function there is<br \/>\n09:01<br \/>\nemerging data on laser and<br \/>\n09:02<br \/>\nradiofrequency however these new<br \/>\n09:05<br \/>\ntechnologies are not currently approved<br \/>\n09:07<br \/>\nor indicated for treatment of female<br \/>\n09:08<br \/>\norgasmic disorder<br \/>\n09:12<br \/>\ngenital pelvic pain penetration<br \/>\n09:14<br \/>\ndisorders include dyspareunia and<br \/>\n09:16<br \/>\nvaginismus treatments for dyspareunia<br \/>\n09:19<br \/>\ncaused by vaginal a traffic changes part<br \/>\n09:22<br \/>\nof the genitourinary syndrome of<br \/>\n09:24<br \/>\nmenopause include non prescription<br \/>\n09:26<br \/>\nmoisturizers which must be used on a<br \/>\n09:28<br \/>\nregular basis to improve the elasticity<br \/>\n09:30<br \/>\nand pliability of genital tissues<br \/>\n09:33<br \/>\nmoisturizers maintain vaginal health<br \/>\n09:35<br \/>\nindependent of coitus in addition there<br \/>\n09:38<br \/>\nare many types of lubricants which are<br \/>\n09:40<br \/>\nused to reduce friction during sexual<br \/>\n09:41<br \/>\nactivity patients should be advised to<br \/>\n09:45<br \/>\nread labels carefully as lubricants have<br \/>\n09:47<br \/>\ndifferent bases only water-based<br \/>\n09:49<br \/>\nlubricants should be combined with<br \/>\n09:50<br \/>\ncondom use for women who do not find<br \/>\n09:54<br \/>\nadequate relief with over-the-counter<br \/>\n09:55<br \/>\nproducts prescription products may be<br \/>\n09:58<br \/>\nadded approved medical prescription<br \/>\n10:00<br \/>\nproducts for dyspareunia such as<br \/>\n10:02<br \/>\nestrogen cream ring tablets or soft gel<br \/>\n10:05<br \/>\ncaps may be considered along with sex<br \/>\n10:08<br \/>\nsteroid vaginal suppositories DHEA<br \/>\n10:10<br \/>\nvaginal inserts or the oral Surma spam<br \/>\n10:13<br \/>\nafine for women who are estrogen<br \/>\n10:16<br \/>\ndeficient these products may also aid in<br \/>\n10:18<br \/>\nlubrication and arousal<br \/>\n10:22<br \/>\nnew terminology now considers vaginismus<br \/>\n10:25<br \/>\npart of GP PPD it is the involuntary<br \/>\n10:28<br \/>\nspasm of the musculature of the outer<br \/>\n10:30<br \/>\nthird of the vagina that interferes with<br \/>\n10:32<br \/>\nsexual intercourse treatment typically<br \/>\n10:35<br \/>\ninvolves systematic desensitization a<br \/>\n10:38<br \/>\ncombination of cognitive and behavioral<br \/>\n10:40<br \/>\npsychotherapy counseling to help a woman<br \/>\n10:42<br \/>\novercome anticipatory anxiety about pain<br \/>\n10:44<br \/>\non penetration and progressive vaginal<br \/>\n10:46<br \/>\ndilation for complicated or<br \/>\n10:51<br \/>\nlong-standing sexual problems or<br \/>\n10:52<br \/>\ndysfunctions you may wish to refer<br \/>\n10:55<br \/>\npatients to a sexual health therapist or<br \/>\n10:57<br \/>\na couples counselor for individual<br \/>\n10:59<br \/>\ncouples or sex therapy or a gynecologist<br \/>\n11:02<br \/>\nwho specializes in sexual disorders<br \/>\n11:05<br \/>\npelvic floor therapy from a qualified<br \/>\n11:07<br \/>\nphysical therapist may also be<br \/>\n11:09<br \/>\nbeneficial you may decide to refer<br \/>\n11:13<br \/>\nbecause you feel you lack the technical<br \/>\n11:14<br \/>\nexpertise to adequately manage the<br \/>\n11:16<br \/>\npatient or because the sexual problem is<br \/>\n11:19<br \/>\nbest served by a multidisciplinary team<br \/>\n11:20<br \/>\napproach when referring be sure to<br \/>\n11:25<br \/>\nnormalize the nature of the patient&#8217;s<br \/>\n11:26<br \/>\nproblem and the commonality of referrals<br \/>\n11:28<br \/>\nto gain the patient&#8217;s acceptance and<br \/>\n11:30<br \/>\nfollow-through with the referral you can<br \/>\n11:33<br \/>\nalso recommend books or other resources<br \/>\n11:35<br \/>\nfor patients to consult about their<br \/>\n11:37<br \/>\nsexual dysfunction there are many<br \/>\n11:40<br \/>\nexcellent consumer books on the market<br \/>\n11:42<br \/>\nsome recommended books are listed here<br \/>\n11:44<br \/>\nand at the end of the video in<br \/>\n11:47<br \/>\nconclusion female sexual dysfunction is<br \/>\n11:50<br \/>\na common problem in the United States<br \/>\n11:52<br \/>\nand sexual health is an important<br \/>\n11:54<br \/>\ncomponent of well woman care across the<br \/>\n11:56<br \/>\nlifespan that can reduce the incidence<br \/>\n11:58<br \/>\nof risky sexual practices sti&#8217;s<br \/>\n12:01<br \/>\nunintended pregnancies and sexual<br \/>\n12:04<br \/>\nassaults gaining confidence and<br \/>\n12:07<br \/>\novercoming discomfort in discussing and<br \/>\n12:09<br \/>\ndiagnosing sexual concerns is critical<br \/>\n12:11<br \/>\nto your competence as a gynecologist in<br \/>\n12:13<br \/>\nthe 21st century you may wish to manage<br \/>\n12:16<br \/>\nsimple sexual problems or you may prefer<br \/>\n12:19<br \/>\nto refer all cases of sexual dysfunction<br \/>\n12:21<br \/>\nto specialists either approach is<br \/>\n12:24<br \/>\nacceptable as long as a woman receives<br \/>\n12:26<br \/>\nthe help she needs to improve her sexual<br \/>\n12:28<br \/>\nand overall health and quality of life<br \/>\n12:39<br \/>\nyou<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Part 1: Counseling Patients About Sexuality \ufeff Duration 11:58 Part II: Treatment for Female Sexual Dysfunction Duration 12:51<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":56,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-101","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=101"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/101\/revisions"}],"predecessor-version":[{"id":2863,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/101\/revisions\/2863"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}