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OB/GYN Editorial AUGUST 2003

Female Sexual Dysfunction: A Topic for Continuing Medical Education

Kirsten Lund, MD; Sonya Erickson, MD

How do residents receive instruction in psychosexual counseling? I still remember our chair posing this question in advance of an accreditation visit from the Residency Review Committee in 1996. Psychosexual counseling was, and still is, a formal requirement for residency training in obstetrics and gynecology. Unfortunately, my fellow residents and I did not have a great answer. "Well," we stammered, "we get some lectures on the subject." Privately, we were too preoccupied with deliveries and surgeries to think about providing care for women with the seemingly unimportant complaint of female sexual dysfunction (FSD). Anecdotally, our residency training seems typical, with most new graduates possessing only rudimentary understanding of FSD. Once in practice, most physicians either learn about this subject on the job, or (unfortunately more commonly) learn to avoid it with their patients.

Obstetrician/gynecologists should feel comfortable managing FSD for many reasons. Approximately 35% to 45% of women report some type of sexual problem, and the majority of gynecologic patients have sexual "concerns," which they rarely address with their doctors.¹ In addition, physiologic events, including childbirth and menopause, can affect women's sexuality. Furthermore, many gynecologic conditions and treatments can affect sexual response. Finally, many women view their OB/GYN as their primary, and often only, health care provider.

The need for formal training in FSD spans the medical education continuum. The Association of Professors of Gynecology and Obstetrics includes sexual function and dysfunction as an educational objective for all medical students. In their words, "all physicians should be able to provide a preliminary assessment of patients with sexual concerns and make referrals when appropriate."²,³ Learning objectives appropriate at this level are being developed.⁴

The Council on Resident Education in Obstetrics and Gynecology (CREOG) has outlined learning objectives in FSD for residents. In their words, "The obstetrician-gynecologist should understand the concepts of sexual development and identity, as well as the psychology of sexual relations. The practitioner also should understand the ways in which a patient's sexuality may be altered by physical or psychologic conditions. The obstetrician-gynecologist should be familiar and comfortable with the terminology used in sexual counseling and should understand the range of disorders of sexual function."⁵ Topics for instruction include the types and etiologies of sexual dysfunction, techniques for obtaining an adequate history, performance of a focused physical examination, and working knowledge of available treatment modalities including counseling, medical therapy, and surgery. Once again, formal curricula for teaching these subjects are being designed.

Recent work by the Sexual Health Council of the American Foundation of Urologic Disease has reclassified FSD into four categories: disorders of sexual desire, sexual arousal, orgasm, and sexual pain.¹,⁶ Additional work has integrated these into intimacy-based and drive-based response cycles.¹ Professional organizations devoted to research and education about human sexuality and its disorders include the Society for the Scientific Study of Sexuality (SSSS) and the American Association of Sex Educators, Counselors, and Therapists (AASECT), both of which sponsor Web sites. The AASECT site helps OB/GYNs locate certified therapists in their area.

Over the years, The Female Patient has published articles about FSD, some of which were available for CME credit.⁷ This journal's ongoing commitment to educating its readership about FSD will unfold in upcoming issues with its periodic series, Sexual Health and Intimacy. Hopefully, this will help all of us move from avoiding this topic to addressing it directly with our patients.

Kirsten Lund, MD
Editorial Board Member

Sonya Erickson, MD
Assistant Professor
Department of Obstetrics and Gynecology
University of Colorado Health Sciences Center, Denver

References:

1. Basson R. Sexuality and sexual disorders. Clin Updates Womens Health Care. 2003;2(1):1-94.
2. The Undergraduate Medical Education Committee. Medical Student Educational Objectives, 7th ed. The Association of Professors of Obstetrics and Gynecology. 1997:44.
3. The Undergraduate Medical Education Committee. Basic Science Prerequisites to a Clerkship in Obstetrics and Gynecology, 2nd ed. The Association of Professors of Obstetrics and Gynecology. 2002:167-169.
4. Multidisciplinary Women's Health Education Task Force. Women's Health Care Competencies: Sample Learning Objectives for Undergraduate Medical Education. The Association for Professors of Obstetrics and Gynecology. 2002:4-5.
5. Educational Objectives: Core Curriculum in Obstetrics and Gynecology, 7th ed. Council on Resident Education in Obstetrics and Gynecology. 2002:35.
6. Basson R, Berman J, Burnett A, et al. Report of the international consensus development conference on female sexual dysfunction. Definitions and classifications. J Urol. 2000;163(3): 888-893.
7. Krychman M, Shulman LP, Brown HP, et al. Sexual dysfunction. The Female Patient. 2001;26(Suppl Nov). 1-24.

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