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

Case studyconsideration is that personal distress must be present toestablish a diagnosis of HSDD. 5,6The approach to management should address anyfactors that might be amenable to intervention, whetheror not they constitute the primary cause of the complaintof loss of sexual desire. In A.J.’s case, a consultation withher psychiatrist is in order to discuss the possible strategiesto lessen the potential impact of her depressive symptomsand antidepressant therapy on her sexual function.Her complaints of vasomotor symptoms and vaginaldryness suggest that she may benefit from systemic estrogentherapy to improve her sleep and reduce daytimefatigue and/or local estrogen therapy to decrease pain onintercourse by increasing vaginal lubrication. However,estrogen therapy does not directly affect sexual desire, sothe patient’s complaints of low desire may well persist. IfReferences1. Basson R, Berman J, Burnett A, et al. Report of theInternational Consensus Development Conferenceon Female Sexual Dysfunction: definitionsand classifications. J Urol. 2000;163:888-893.2. Bonierbale M, Lancon C, Tignol J. The ELIXIRstudy: evaluation of sexual dysfunction in 4,557depressed patients in France. Curr Med Res Opin.2003;19:1114-11224.3. Kennedy SH, Dickens SC, Eisfeld BS, et al.Sexual dysfunction before antidepressanttherapy in major depression. J Affect Disord.1999;56:2001-2008.4. Meston CM, Bradford A. Sexual dysfunctions inwomen. Annu Rev Clin Psychol. 2007;3:233-256.5. American Psychiatric Association. Diagnosticand Statistical Manual of Mental Disorders. 4thedition, text revision. Washington, DC: AmericanPsychiatric Press; 2000.6. Basson R, Schultz WW. Sexual sequelae of generalmedical disorders. Lancet. 2007;369:409-424.7. Simon J, Braunstein G, Nachtigall L, et al. Testosteronepatch increases sexual activity and desireso, a trial (off-label) of testosterone therapy may be appropriate,as testosterone treatment may be effective insignificantly increasing sexual desire and decreasing distressin naturally menopausal women with HSDD whenused concomitantly with estrogen replacement therapy. 7Testosterone therapy, in combination with estrogen, hasalso been shown to improve arousability, fantasy, orgasm,and overall sexual satisfaction in women with HSDD. 8 Arecent trial investigating the use of testosterone alone innaturally menopausal women with low desire has demonstratedmodest dose-dependent improvements in sexualsatisfaction with this therapy. 9 nDisclosureDr. Parish is a consultant for Boehringer Ingelheim Pharmaceuticals, Inc.,and Wyeth.in surgically menopausal women with hypoactivesexual desire disorder. J Clin Endocrinol Metab.2005;90:5226-5233.8. Abdullah RT, Simon JA. Testosterone therapy inwomen: its role in the management of hypoactivesexual desire disorder. Int J Impotence Res.2007;19:458-463.9. Davis SR, Moreau M, Kroll R, et al. Testosteronefor low libido in postmenopausal women nottaking estrogen. N Engl J Med. 2008;359:2005-2017.instructions forreceiving creditContinuing Education CreditThere are 2 optionsfor receiving credit:1. A diagnosis of hypoactivesexual desire disorder (HSDD)in women involves:a. Overlap with another femalesexual dysfunctionb. Personal distressc. Decreased androgen levelsd. Transition through menopause2. Unlike HSDD, female sexualaversion disorder involves:a. Avoidance of all or almost allgenital sexual contactb. Inability to attain an adequatelubrication responsec. Personal distressd. Absence of sexual fantasies3. The prevalence of HSDD:a. Has been decreasing in recent years,according to epidemiologic studiesb. Has generally been reportedas 50 years old4. The PRESIDE study showed that themost common sexual complaintamong US women is:a. Low sexual desireb. Lack of sexual arousalc. Failure to achieve orgasmd. Erectile dysfunction in partnerOption 1:The DIME online enrollment systema. Please visit the url:www.DIMedEd.org/updates/HSDDFamilyPractice.htmlb. Complete the enrollment form,posttest, and evaluation.c. Successful completion of the selfassessmentis required to earnCategory 1 CME credit. SuccessfulPlease Circle or check the correct answer to each question.Release date: July 15, 2009Expiration date: July 15, 2010CME Posttest5. Survey data have revealed thatthe identification of female sexualdysfunction is hampered by:a. The rarity of these conditionsb. A lack of simple screening toolsc. Patient concerns that the physicianwill be embarrassedd. The reluctance of physicians torefer patients to specialists6. Which of the followingphysician characteristics was citedas increasing patient comfort indiscussing sexual issues,according to 90% of womensurveyed?a. Number of years in clinical practiceb. Solo vs group practicec. Having seen the patient befored. Never having seen the patient before7. Which of the following medicalsituations should prompt screeningfor female sexual problems?a. Diagnosis of diabetesb. Early postnatal periodc. Presence of adrenal diseased. All of the above8. A recent survey found that thevast majority of family physiciansscreen their female patientsfor HSDD.a. Trueb. Falsecompletion is defined as a cumulativescore of at least 70% correct. If youreceive a passing score, your certificateof credit will be made available to youimmediately.If you have difficulty accessing thelink, please contact the DIME officeat (312) 553-8000 or dimeservices@DIMedEd.orgOption 2:Complete this enrollment form,posttest, and evaluation form andmail them to:DIME 17771222 Merchandise Mart PlazaSuite 4-160Chicago, IL 60654A certificate of credit will be e-mailedor mailed to you within 6 weeks.Estimated time to complete activity: 1.25 hours9. Studies of pharmacologictherapies for HSDD haveshown that:a. Drugs used to treat erectiledysfunction in men are consistentlyeffective in womenb. Bupropion improves all measuresof sexual functionc. Dopaminergic agents providethe greatest efficacyd. None of the above10. Which of the followingstatements is not true?a. Data have confirmed thattransdermal testosterone improvessymptoms of HSDDb. Estrogens have a greater impacton female sexual function thando androgensc. Studies of dehydroepiandrosteronein women with HSDD have yieldedconflicting resultsd. More data are needed todetermine whether flibanserin iseffective in women with HSDDS32 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 S33