Outcomes & Objectives

Outcomes

• Providers will be educated about the prevalence and classification of sexual disorders and improve their detection and evaluation of these problems in an array of clinical settings.
• Practitioners will perform well-organized interviews with female patients with sexual problems and their partners.
• HCPs will screen women for DSM 5 sexual dysfunctions on a routine basis using validated screening tools.
• Improvement in competence of HCPs resulting in better patient (and partner) understanding of the specific dysfunction, potentially better treatment compliance and finally better patient outcomes.
• Fair-balanced education about psychosexual sources of and treatment for sexual dysfunction will be taught and translated into clinical practice.
• Patient outcome is improved as shown by FSFI increasing and SDS-R decreasing.
• A thorough review of the data, risks, and benefits in different patient circumstances, presentations of the choices and options available to patients, and key discussion points will lead to improvement in the practitioner's knowledge and ability to inform and treat patients.
• Clinicians will utilize evidence regarding testosterone therapy efficacy and safety in the management strategies for HSDD.
• HCPs learn how to counsel patients about the benefits and risks associated with off label testosterone use and to advise patients in selecting various off label testosterone treatments available.
• By reviewing the evidence-based data regarding the efficacy, risks, and benefits of both hormonal and non-hormonal GSM treatment options, HCPs can better educate their patients and facilitate the decision-making process when it comes to managing this common condition.
• Fair-balanced, scientific education about contraceptive methods and sexual function.
• HCPs should obtain a dyspareunia history and physical examination regularly when assessing a patient complaining of dyspareunia.
• Fair-balanced, scientific education about sexual pain generators will be taught and translated into clinical practice.
• The practitioner will be able to determine the different causes of dyspareunia and therefore better able to treat it appropriately.
• Fair-balanced, scientific education about HPV and vulvar disease will be taught and translated into clinical practice.
• Fair-balanced, scientific education about treatment for dyspareunia will be taught and translated into clinical practice.
• Patients with vulvar pain resulting mainly from neuroproliferative vestibulodynia who fail conservative treatment options require surgical intervention so a better understanding of this diagnosis and treatment will result in more women with the problem being effectively treated.
• Patients have multiple versions of orgasmic dysfunction and each is managed logically and rationally.
• Providers will fully evaluate women with sexual problems and psychiatric co-morbidity and implement evidence-based treatment strategies that address the complex relationship between these clinical conditions.
• Sexual function assessments are performed at baseline, throughout treatment and during survivorship in order to develop fair-balanced scientific information on the impact of breast cancer and its treatment on sexual health. Acknowledging sexual problems and referring to a sexual health clinician becomes part of standard oncologic care. There is systematic patient assessment and education by the oncologist in collaboration with a specialist in sexual medicine. Multidisciplinary care programs are implemented at cancer centers and medical centers that take care of women with breast cancer.
• Systematic assessment of all women presenting for well visits as well as specific dysfunctions, including additional appointments in order to manage patients effectively.
• Systematic assessment of sexual health as part of the diagnosis including the ability of the HCP to establish a diagnosis of sexual  problems and dysfunctions; and counseling and treatment of women with sexual dysfunction before and after treatment either by trained gynecologists or in the context of a multidisciplinary team.
• Improved knowledge and cultural competency in addressing sexual health concerns among refugee/immigrant communities.
• Using diagnostic tools such as vulvoscopy and QST allows the HCP to give a more exact diagnosis and therefore provide a more targeted treatment.
• The sexual problems become part of oncologic care before or at the time of the treatment and during the post-treatment follow up phase. There is systematic patient assessment and education by the HCP.
• Comprehensive biopsychosocial care of patients to individually assess their health needs including prevention and quality of life, practicing shared decision-making to help patients get the most benefit and least risk from their HT, while allowing for a comfortable course of therapy unique to their individual needs, whether short or longer term.
• Fair-balanced, scientific education about musculoskeletal sources of sexual dysfunction will be taught and translated into clinical practice.
• HCPs can easily incorporate some basic counseling by changing the language they use when eliciting their patient's sexual health history, and recommend sex therapy from a professional when appropriate.
• Improvement in the number of HCPs willing to manage PGAD will lead to more women able to be helped as they often are unable to travel to see a specialist.
• Patients are educated about the relationship between OAB and/or urinary incontinence and sexual dysfunction, as well as potential orgasmic dysfunction as a result of sling surgery for incontinence.
• Better understanding of off-label and future treatments for various sexual dysfunctions in women that may one day be approved treatments for these indications.
• Education regarding use of coding and specific billing practices can facilitate success in clinical practice.
• A multifactorial systems approach to integrated sexual medicine care implementing the biopsychosocial model provides for a best case scenario for the patient.
• Fair-balanced, scientific education about vaginal lubricants, moisturizers and vulvar creams for use in women with sexual dysfunction will be taught and translated into clinical practice.
• Proper assessment of a woman's sexual practices, addressing both her satisfaction while focusing on safety, consent and wellbeing. Compulsive and out of control behavior will be addressed along with tools to help manage these behaviors and to identify proper referrals.
• Case reports allow attendees to interact with faculty to discuss interpretation of diagnostic testing and make treatment recommendations that can later be used in their practices.

Objectives

Upon completion of this activity, participants should be better able to:

• (1) Understand the broad epidemiology, prevalence, classification systems and models for female sexual disorders in clinical practice. (2) Identify changes in definitions in the transition from DSM IV-TR to DSM 5.
• (1) Utilize demonstration interview with a live patient to teach optimal sexual problem history taking. (2) Utilize demonstration interview with a live patient and her partner to teach optimal sexual problem history taking when a couple is involved.
• (1) Develop skills that allow for discussing sexual concerns with female patients. (2) Review content to be covered in screening and diagnosis.
• (1) Cite the pathophysiology of hormonal, vascular and neurologic causes of sexual dysfunction in women. (2) Describe the various diagnostic tests needed to properly diagnose a women with sexual dysfunction.
• (1) Describe the specific assessment for sexual dysfunction related to psychosexual factors.  (2) Cite contemporary sex therapy techniques for female sexual dysfunction.
• (1) Cite rational and logical use of treatments affecting central excitatory neurotransmitters. (2) Describe rational and logical use of treatments affecting central inhibitory neurotransmitters.
• (1) Apply relevant data and appropriate individual choices to the education of both HCPs and patients in order to guide them through the process of menopausal HT decision-making. (2) Analyze the major differences in available hormone therapies to help individualize the treatment and enhance the benefits while decreasing the risks for the menopausal patient.
• (1) Discuss the efficacy of testosterone therapy for HSDD in women. (2) Discuss the safety of testosterone therapy for HSDD in women.
• (1) Identify the benefits and risks associated with off label testosterone use for Hypoactive Sexual Desire Disorder (distressing low sexual desire). (2) Compare and contrast the off label use of various FDA-approved male products in women and compounded testosterone treatment options.
• (1) Recognize the clinical manifestations of Genitourinary Syndrome of Menopause (GSM) and the underlying pathology. (2) Apply evidence-based treatment options, both hormonal and non-hormonal, to the management of GSM.
• (1) Describe the potential positive impact of various contraceptive methods on sexual function. (2) Identify the potential negative impact of various contraceptive methods on sexual function.
• (1) Learn the true prevalence of dyspareunia.  (2) Learn the important anatomic landmarks to examine in the physical exam for a woman with dyspareunia.
• (1) Describe the possible sources of sexual pain related to skin, musculoskeletal, neuroproliferative, hormonal and genitourinary factors. (2) Explain the technique for systematic assessment of the vulva, vestibule and pelvic floor muscles.
• (1) Know the three most common causes of dyspareunia. (2) Learn the appropriate aspects of the medical history and physical examination that determine the cause of the dyspareunia.
• (1) Describe the vulvoscopic presentations of VIN and non-neoplastic vulvar dermatologic conditions (2) Indicate when to biopsy for diagnostic purposes.
• (1) Describe 4 types of oral medication that can be used in the treatment of dyspareunia. (2) Review the purpose and efficacy of pelvic floor physical therapy when treating patients with dyspareunia.
• (1) Describe a total vestibulectomy with vaginal advancement flap and excisional therapy for introital constriction.  (2) Indicate why a partial vestibulectomy is not a practical option for a positive patient outcome.
• (1) Differentiate among different types of orgasms. (2) Describe various aspects of orgasm compromise.
• (1) Describe the relationship between common psychiatric disorders in women, particularly depression, and female sexual dysfunctions. (2) Provide an evidenced-based approach to the appropriate use of psychopharmacological agents in this clinical context.
• (1) Understand the impact of breast and gynecologic cancer and its therapy on female sexual health. (2) Identify how to address sexual problems in breast and gynecologic cancer patients. (3) Describe supportive measures used to treat sexual dysfunction in cancer survivors. (4) Identify the controversy surrounding the usage of hormonal products in women with breast and gynecologic cancer. (5) Apply a multidisciplinary treatment approach to female sexual dysfunction in the cancer survivor (sexual rehabilitation).
• (1) Apply appropriate practice model to HCP's practice to effectively incorporate management within current practice. (2) Evaluate effectiveness of practice model within HCP's current practice.
• (1) Characterize the impact of benign gynecologic disorders on sexual function from clinical experiences and from studies. (2) Integrate information and education for patients in the diagnostic and therapeutic process. (3) Apply the best practice treatment (evidence based or experienced based) in the case of dysfunctions.
• (1) To draw attention to cross-cultural issues relevant to women's sexual health that reflects current trends in refugee and immigrant resettlement in the U.S. (2) To provide key pearls on enhancing quality care in caring for survivors of sexual and gender-based violence and women who have experienced Female Genital Cutting.
• (1) Distinguish when to use which diagnostic test in which specific patient. (2) Discriminate between various sexual dysfunctions in women based on the diagnostic testing results.
• (1) Learn how to address sexual problems in cancer patients. (2) Establish a descriptive diagnosis. (3) Explore the contributing general, disease or treatment specific biological, psychological and social factors. (4) Apply a multidisciplinary treatment approach to female sexual dysfunction in the cancer survivor.
• (1) Establish a biopsychosocial diagnosis of each menopausal patient assessing her individual health needs and priorities. (2) Discriminate between oral and non-oral estrogen routes of administration with respect to differences in risk. (3) Alter dosing and regimen in response to patient concerns and side effects with a particular hormone therapy. (4) Apply better counseling to patients in anticipation of common complications/side effects from their use of hormone therapy. (5) Inform decision making regarding the full range of progestogen options with respect to dose and regimen to better suit specific patient needs.
• (1) Describe the specific assessment for sexual dysfunction related to musculoskeletal factors.  (2) Cite contemporary treatments for sexual dysfunction related to musculoskeletal factors.
• (1) Review the goals of office-based counseling for non-mental health professionals. (2) Practice office-based counseling techniques with standardized patients.
• (1) Characterize the underlying pathophysiologies leading to PGAD. (2) Associate therapeutic strategies with specific pathophysiologies of PGAD.
• (1) Cite relationship between OAB and sexual dysfunction in women. (2) Describe how placement of a sub-urethral sling can cause orgasmic disorders.
• (1) Characterize the pharmacologic agents being developed for FSD and review the off-label treatments currently used for this indication.  (2) Describe the devices in use and being developed for FSD.
• (1) Describe the common ICD codes relevant to sexual medicine.  (2) Name the common CPT codes relevant to sexual medicine.
• (1) Understand the biopsychosocial model of sexual function and the barriers to implementing it in a practice setting.  (2) Appreciate the financial implications of an integrated sexual medicine practice, how to avoid business pitfalls and provide value added services to complement patient care.
• (1) Describe the specific action and indications for use of vaginal lubricants and moisturizers. (2) Give examples of over the counter products used in the treatment of sexual dysfunction.
• (1) Review various paraphilias. (2) Define compulsive and addictive sexual behaviors. (3) Review comprehensive sexual practice assessment focusing on paraphilias and compulsive behavior. (4) Review treatment options for women whose practices are causing physical and psychosocial harm.
• (1) Apply principles of diagnosis to real life situations. (2) Apply principles of a treatment algorithm to real life situations.