Outcomes & Objectives

Target Audience

Potential attendees of the courses include (but or not limited to) physicians, residents, students, nurse practitioners, physical therapists and sex therapists.

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 providers resulting in better patient (and partner) understanding of the specific dysfunction, potentially better treatment compliance and finally better patient outcomes.
• Fair-balanced, scientific education about sexual enhancement products for use in women with sexual dysfunction as well as introduction of the PLISSIT model to guide in office counseling will be taught as well as translated for use in clinical practice.
• 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.
• 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.
• 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.
• Patients have multiple versions of orgasmic dysfunction and each is managed logically and rationally.
• 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.
• The sexual problems become part of oncologic care even before the treatment and during the posttreatment follow up phase. There is systematic patient assessment and education by the oncologist in collaboration with a specialist in sexual medicine. Multidisciplinary care programs are implemented.
• Fair-balanced, scientific education about contraceptive methods and sexual function.
• Obtaining 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.
• 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.
• Providers 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 nonhormonal GSM treatment options, healthcare providers can better educate their patients and facilitate the decision-making process when it comes to managing this common condition.
• Systematic assessment of sexual health as part of the diagnosis including the ability of the clinician to establish a diagnosis of sexual  problems and dysfunctions; Counseling and treatment of women with sexual dysfunction before and after treatment either by trained gynecologists or in the context of a multidisciplinary team.
• Better understanding of off-label and future treatments for FSD that may one day be approved treatments for this indication.
• Increased diagnostic accuracy and disorder specific treatment for dyspareunia facilitated by using a diagnostic algorithm to determine the specific cause of dyspareunia.
• Using diagnostic tools such as vulvoscopy and QST allows the provider to give a more exact diagnosis and therefore to provide a more targeted treatment.
• 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.
• Clinicians will use the motivational interviewing technique Ask-Tell-Ask, which assesses the patient's prior knowledge/experience as well as the patient's reactions to a recommended treatment strategy, when counseling patients about sexual problems.
• Education regarding use of coding and specific billing practices can facilitate success in clinical practice.
• Improvement in the number of providers willing to manage PGAD will lead to more women able to be helped as they often are unable to travel to see a specialist.
• Increased diagnosis and proper treatment of the specific vulvar dermatoses.
• 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.
• 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.
• 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.
• A multifactorial systems approach to integrated sexual medicine care implementing the biopsychosocial model provides for a best case scenario for the patient.

Objectives

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

• (1) Describe the broad epidemiology, prevalence, classification systems and models for female sexual disorders in clinical practice. (2) Identify changes from DSM IV to DSM 5.
• (1) Utilize demonstration interview with a live patient, and her partner when a couble is involved, to teach optimal sexual problem history taking.
• (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 indications for use of and differences between vaginal lubricants, moisturizers and vulvar creams in the treatment of sexual dysfunction; (2) List potential irritants and caustic additives that may hinder sexual comfort; (3) Discuss the types of vibrators and their use; (4) Apply the PLISSIT model and behavioral therapy principles in clinical practice.
• (1) Describe the specific assessment for sexual dysfunction related to psychosexual factors.  (2) List contemporary sex therapy techniques for female sexual dysfunction.
• (1) Cite and describe rational and logical use of off-label treatments affecting central excitatory neurotransmitters.
• (1) Describe the relationship between common psychiatric disorders in women, particularly depression, and female sexual dysfunctions. (2) Assess the latest evidenced-based approach to the appropriate use of psychopharmacological agents in this clinical context.
• (1) Discuss relationship between OAB and sexual dysfunction in women. (2) Describe how placement of a sub-urethral sling can cause orgasmic disorders.
• (1) Differentiate between differentiate among of orgasms. (2) Describe various aspects of orgasm compromise.
• (1) Discuss the impact of breast cancer and its therapy on female sexual health. (2) Identify how to address sexual problems in breast cancer patients. (3) Describe supportive measures used to treat sexual dysfunction in breast cancer survivors. (4) Identify the controversy surrounding the usage of hormonal products in women with breast cancer. (5) Apply a multidisciplinary treatment approach to female sexual dysfunction in the breast cancer survivor (sexual rehabilitation).
• (1) Manage sexual problems in gynecologi cancer patients. (2) Apply a multidisciplinary treatment approach to female sexual dysfunction in the gynecologic cancer survivor (sexual rehabilitation).
• (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) Discuss true prevalence of dyspareunia.  (2) Identify important anatomic landmarks to examine in an 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) Define the three most common causes of dyspareunia. (2) Explain 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) Explain 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 PT when treating patients with dyspareunia.
• (1) Describe a total vestibulectomy with vaginal advancement flap and excisional therapy for introital constriction. (2) Explain why a partial vestibulectomy is not a practical option for a positive patient outcome.
• (1) Apply relevant data and appropriate individual choices to the education of both practitioners 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 and safety of testosterone therapy for Hypoactive Sexual Desire Disorder 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 nonhormonal, to the management of GSM.
• (1) Describe 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) Discuss 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) Cite the causes and treatment of hormonally mediated vestibulodynia. (2) Outline the causes and treatment of hypertonic pelvic floor muscle dysfunction, neuroproliferative vestibulodynia and of desquamative inflammatory vaginitis.
• (1) Distinguish when to use which diagnostic test in which specific patient. (2) Know the difference between various sexual dysfunctions in women based on the diagnostic testing results.
• (1) Determine a biopsychosocial diagnosis of your menopausal patient assessing her individual health needs and priorities. (32) Know the difference between oral and non-oral estrogens 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) Describe progestogen options with respect to dose and regimen to improve patient care.
• (1) Describe the specific assessment for sexual dysfunction related to musculoskeletal factors.  (2) Explain contemporary treatments for sexual dysfunction related to musculoskeletal factors.
• (1) Understand the purpose of the Ask-Tell-Ask technique in sexual problem counseling for female sexual dysfunctions.  (2) Implement the patient-centered, collaborative motivational interviewing technique Ask-Tell-Ask in a practice setting.
• (1) Describe and name the common ICD and CPT codes relevant to sexual medicine.
• (1) Describe the underlying pathophysiologies leading to PGAD. (2) Discuss therapeutic strategies with specific pathophysiologies of PGAD.
• Recognize and treat lichen sclerosus, lichen planus, lichen simplex chronicus.
• (1) Apply principles of diagnosis and treatment algorithm to real life situations. 
• (1) Review the goals of office-based counseling for non-mental health professionals. (2) Apply office-based counseling techniques with standardized patients.
• (1) Describe the specific action and indications for use of vaginal lubricants and moisturizers.  (2) Discuss over the counter products used in the treatment of sexual dysfunction.
• (1) Explain the biopsychosocial model of sexual function and the barriers to implementing it in a practice setting. (2) Discuss the financial implications of an integrated sexual medicine practice, how to avoid business pitfalls and provide value added services to complement patient care.