Identifying Female Sexual Dysfunction in Primary Care

Background: Female sexual dysfunction (FSD) commonly affects women across the lifespan though many components of FSD are easily treatable or improved with education. Many clinicians are ill-equipped to address FSD with patients in their daily practice due to a lack of training in their educational programs. Local Problem: Clinicians in the target clinics were not regularly screening for FSD. The aim of this quality improvement project was to integrate FSD screening in a primary care setting using a validated tool, the Female Sexual Function Index-6 (FSFI-6), incorporated into the template for woman exams. A toolkit was also made available for providers as well as additional educational resources for patients. Methods: A pre- and post-implementation survey was given to participating providers in 3 separate outpatient clinics to assess current practices, comfort, and confidence with FSD. The screening was then integrated into the annual exam template used for electronic health record (EHR) documentation. An in-person meeting with participating clinicians was conducted to familiarize them with the project objectives and intervention. An email containing a written overview of the project with instructions, tool kit link, and survey link was disseminated to clinicians at all three sites. Following the intervention, chart audits were performed to determine provider use and documentation of the tool, toolkit, and patient resources. Intervention: The FSFI-6 was administered to patients who identified sexual function concerns when seen for their annual well-woman exam over a period of 12 weeks. A score was entered in the EHR. Clinicians were encouraged to review the FSFI-6 score and use the toolkit with patients to educate or refer to a specialist if indicated. Results: 446 annual exams were conducted in three clinics by 19 providers, 13 of whom were active participants during implementation. A total of 223 (50%) patients were assessed for FSD concerns and of these, 39 (8.7%) indicated concerns and completed the FSFI-6 screening. Of those screenings, 18 (46%) screened positive for FSD. Ten (55%) patients were provided additional resources and 3 (16.7%) were referred to specialists. Three (23%) providers completed the pre-implementation survey and 7 (53.8%) completed the post-implementation survey. Comparison of providers' scores to determine improvement in knowledge of, comfort with, and confidence in addressing FSD could not be measured due to low survey response rates. Conclusion: In all, 18 patients had FSFI-6 scores that indicated problematic sexual dysfunction. Low survey response rates did not permit measurement of clinicians' knowledge and comfort in screening for FSD. Incorporation of the FSFI-6 into the annual well woman visit template was shown to be an effective and efficient approach to identify and address concerns related to sexual function.