S16 From whence comes HSDD? - The Journal of Family Practice

HypoactiveSexual Desire Disorderin WomenImplications for Family PracticeAvailable at www.jfponline.com Vol 58, No 7 / July 2009ChairpersonSharon J. Parish, MDFacultySheryl A. Kingsberg, PhDJames A. Simon, MD, CCD, NCMP, FACOGEditorsNatasha Mitchner, PhDScientific Director, DIMEChicago, IllinoisNancy BaxterDIMEChicago, IllinoisTarget AudienceThis activity is targeted to family and general practitionersin primary care.Activity PurposeDIME’s educational goal is to assist participantswith the diagnosis and treatment of HSDD byincreasing knowledge of screening tools, strategiesfor patient–provider communication, and treatmentoptions.This activity may be accessed via the Internet onwww.jfponline.com.Term of OfferingThis activity has a release date of July 15, 2009, and isvalid for 1 year. Requests for credit must be receivedno later than July 15, 2010.A review committee has agreed that this materialcan be completed in 1.25 hours. This estimatedstudy time in turn has determined the credit hoursbeing offered.All inquiries should be directed to:DIME222 Merchandise Mart PlazaSuite 4-160Chicago, IL 60654DIMEinfo@DIMedEd.orgwww.DiMedEd.orgAccreditation AND DESIGnation StatementDIME is accredited by the Accreditation Council forContinuing Medical Education (ACCME) to providecontinuing medical education for physicians.DIME designates this educational activity for amaximum of 1.25 AMA PRA Category 1 Credits TM .Physicians should only claim credit commensuratewith the extent of their participation in the activity.continuing education creditThis activity includes a posttest and evaluation,which must be completed to receive continuingeducation credit.There is no fee for participating in the programor for the generation of the certificate.instructions for receiving creditContinuing Education CreditThere are 2 options for receiving CME credit:Option 1: The DIME online enrollment systema. Please visit the url: http://www.DIMedEd.org/updates/HSDDFamilyPractice.htmlb. Complete the enrollment form, posttest, andevaluation.c. Successful completion of the self-assessment isrequired to earn Category 1 CME credit. Successfulcompletion is defined as a cumulative score ofat least 70% correct. If you receive a passing score,your certificate of credit will be made available toyou immediately.If you have difficulty accessing the link, pleasecontact the DIME office at (312) 553-8000 ordimeservices@DIMedEd.orgOption 2: Complete this enrollment form, posttest,and evaluation form and mail them to:DIME 17771222 Merchandise Mart Plaza, Suite 4-160Chicago, IL 60654A certificate of credit will be e-mailed or mailed toyou within 6 weeks.Statement of NeedHypoactive sexual desire disorder (HSDD), thepersistent or recurrent lack of sexual fantasies,thoughts, and desires resulting in personal distress,is one of 4 categories of female sexual dysfunction.Providers are known to consistently underestimateand underrecognize their patients’ sexual problems.A stigma associated with communicatingabout sex, cultural embarrassment, and avoidanceof discussion of sexual dysfunction in theclinical environment are common barriers thatprevent providers and patients from talking aboutsex. In addition, type of sexual dysfunction, duration,and frequency of satisfying sexual events aredifficult to track and quantify and are limited byprovider emphasis and patient adherence to tracking.The causal dimensions of HSDD are extremelybroad and are not fully understood. The clinicalevaluation of HSDD should consider biological,interpersonal, and psychological factors. Providersmay perceive that there is simply a lack of scheduledoffice time to discuss sexual concerns, especially ifthe provider believes that a good assessment requiresa substantial investment of time. Stigma,fear, embarrassment, discomfort (or a provider’soverconfidence in the patient’s comfort level), andeven the gender difference between the patient andprovider may alter the interpersonal dynamics ofthe office visit. Approaches are needed to overcomebarriers to recognizing sexual dysfunction andHSDD and to establish more effective dialogue andfacilitate referral to appropriate resources.Learning ObjectivesOn completion of this activity, participants shouldbe able to:• Define HSDD and identify the factors associatedwith it or that may contribute to it• Describe the steps required for taking a thoroughand clinically pertinent sexual history• Explain how to screen patients for HSDD, howto identify and diagnose patients at risk forHSDD, and how to refer them to appropriateresources• Identify interventions and pharmacologic treatmentsfor HSDD and provide evidence of theireffectiveness• Discuss patient and provider obstacles to therecognition and management of HSDD andidentify strategies for overcoming these barriersThis activity is funded through an independenteducational grant from Boehringer IngelheimPharmaceuticals, Inc. The activity content was developedindependently by the contributing facultyor editors. The materials included in this activityhave undergone peer review by the chairperson(s)or editor(s). All materials are included with the permissionof the authors. The opinions expressed arethose of the faculty and are not to be construed asthose of the publisher or grantor.DisclosuresIn accordance with DIME policies regarding financialand off-label disclosure, the learner is advisedthat this CME activity may contain references to offlabelor unapproved uses of drugs or devices. Theuse of these agents outside currently approved labelingis considered experimental, and participantsare advised to consult prescribing information forthese products. This CME activity was planned andproduced in accordance with ACCME EssentialAreas and Policies.DIME requires that all persons who were in aposition to control or influence the content of thisCME activity disclose all relevant financial relationshipswith any commercial interest. This informationis used to: (1) determine whether a conflictexists, (2) resolve the conflict by initiating a contentvalidation process, and (3) advise learners of thisinformation.ChairpersonSharon J. Parish, MDSources of Funding for Research: NoneConsulting Agreements: Boehringer IngelheimPharmaceuticals, Inc.; Wyeth PharmaceuticalsFinancial Interests/Stock Ownership: NoneSpeakers’ Bureau/Honorarium Agreements: NoneDiscussion of Off-Label, Investigational, or ExperimentalDrug Use: Androgen therapy, includingtestosterone and DHEA for hypoactive sexualdesire.FacultySheryl A. Kingsberg, PhDSources of Funding for Research: BioSante Pharmaceuticals;Boehringer Ingelheim Pharmaceuticals,Inc.; Procter & Gamble PharmaceuticalsConsulting Agreements: Boehringer IngelheimPharmaceuticals, Inc.; Wyeth PharmaceuticalsFinancial Interests/Stock Ownership: NoneSpeakers’ Bureau/Honorarium Agreements: Eli Lillyand Company; Johnson & JohnsonDiscussion of Off-Label, Investigational, or ExperimentalDrug Use: Testosterone for postmenopausalwomen.James A. Simon, MD, CCD, NCMP, FACOGSources of Funding for Research: BioSante Pharmaceuticals;Boehringer Ingelheim Pharmaceuticals,Inc.; FemmePharma Global Healthcare, Inc.; Glaxo-SmithKline; Nanma/Tripharma/Trinity; NovartisPharmaceuticals Corp; Procter & Gamble PharmaceuticalsConsulting Agreements: Allergan Inc.; Alliance forBetter Bone Health; Amgen Inc.; Ascend Therapeutics,Inc.; Barr Pharmaceuticals, Inc.; BayerHealthCare Pharmaceuticals; BioSante Pharmaceuticals;Boehringer Ingelheim Pharmaceuticals,Inc.; Concert Pharmaceuticals, Inc.; Corcept TherapeuticsIncorporated; Depomed, Inc.; GlaxoSmith-Kline; KV Pharmaceutical Company; MeditrinaPharmaceuticals, Inc.; Merck & Co., Inc.; MerrionPharmaceuticals, Inc.; Nanma/Tripharma/Trinity;Novogyne Pharmaceuticals; Novo Nordisk A/S;Pear Tree Pharmaceuticals; QuatRx PharmaceuticalsCompany; Roche; Schering-Plough Corporation;Sciele Pharma, Inc.; Solvay Pharmaceuticals,Inc.; Ther-Rx Corporation; Warner Chilcott; WyethPharmaceuticalsFinancial Interests/Stock Ownership: NoneSpeakers’ Bureau/Honorarium Agreements: AmgenInc.; Ascend Therapeutics, Inc.; Barr Pharmaceuticals,Inc.; Bayer HealthCare Pharmaceuticals;Boehringer Ingelheim Pharmaceuticals, Inc.;GlaxoSmithKline; KV Pharmaceutical Company;Merck & Co., Inc.; Novartis Pharmaceuticals Corp;Novogyne Pharmaceuticals; Sciele Pharma, Inc.;Ther-Rx Corporation; Warner Chilcott; Wyeth PharmaceuticalsDiscussion of Off-Label, Investigational, or ExperimentalDrug Use: Testosterone for postmenopausalwomen.EditorsNatasha Mitchner, PhDSources of Funding for Research: NoneConsulting Agreements: NoneFinancial Interests/Stock Ownership: Procter &Gamble PharmaceuticalsSpeakers’ Bureau/Honorarium Agreements: NoneDiscussion of Off-Label, Investigational, or ExperimentalDrug Use: NoneNancy BaxterSources of Funding for Research: NoneConsulting Agreements: NoneFinancial Interests/Stock Ownership: NoneSpeakers’ Bureau/Honorarium Agreements: NoneDiscussion of Off-Label, Investigational, or ExperimentalDrug Use: NoneThis activity is sponsored by DIME and fundedthrough an independent educational grant fromBoehringer Ingelheim Pharmaceuticals, Inc.image © Michael MorgesternS14 July 2009 / Vol 58, No 7 / Supplement to The Journal of Family Practice Copyright © 2009 Dowden Health Media and DIME www.jfponline.comSupplement to The Journal of Family Practice / Vol 58, No 7 / July 2009 S15