Assessing Female Sexual Dysfunction: Creating a Tool for Improved Diagnosis

Despite the high prevalence of female sexual dysfunction (FSD) in the United States, it is both under diagnosed and undertreated. This is largely attributed to the difficulty in establishing a diagnosis consistent with DSM-V criteria while simultaneously excluding the many confounding variables that can affect sexuality. The high prevalence of FSD can be accredited to a number of risk factors specific to both the female reproductive cycle and the culturally taboo nature of sexuality. Pregnancy, childbirth, and menopause are all reproductive events correlated with the propensity for sexual dysfunction. Lack of basic education on anatomy and sexuality to youth provides the opportunity for sexual dysfunction to manifest as women come into their reproductive prime. When FSD goes undiagnosed and untreated, multiple health outcomes can be seen. Sexual dysfunction is correlated with increased rates of depression and anxiety, and resulting sexual inactivity in older adults is correlated with diabetes, hypertension, and hyperlipidemia. When appropriately treated, not only do both mental and physical health improve, but the resulting sexual satisfaction is also associated with higher levels of cognitive functioning in the aging population. Currently there are limited assessment tools available to aid with diagnosis of FSD, and none encompass the varying etiologies that can be attributed to dysfunction. This leaves the onus on providers to make an accurate diagnosis based on subjective history alone. The amount of time necessary to arrive at this diagnosis without an assessment tool proves to be a barrier for many providers. The purpose of this project was to create an assessment tool that could aid providers in establishing an accurate diagnosis of sexual dysfunction. The objectives were to 1) develop a FSD assessment tool using a multidisciplinary approach that could be implemented in a clinic setting, 2) assess provider acceptance and opinion regarding the tool, and 3) disseminate the tool to a larger audience through a professional organization. The implementation of this project started with research into the topic of sexual dysfunction, including the attendance of a provider training specific to FSD, time in a sexual dysfunction specialty clinic, and an extensive literature review. This preparation allowed for a ten-page assessment tool to be developed containing over 50 items, broken down into sub-categories that encompass medical, surgical, and sexual histories. Targeted providers specializing in sexual dysfunction provided feedback through structured interviews. Dissemination of the finalized assessment tool took place as a podium presentation at the local chapter meeting of the American College of Nurse-Midwives in April 2017.