Sexual Health

CMECNE

A Patient Complains of Low Sexual Desire – Making an Accurate Diagnosis

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Compare symptoms of low sexual desire to those of low sexual arousal
2. Outline a course of questions which will allow you to distinguish between low desire and problems with arousal

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

It is often difficult for patient to differentiate between desire / libido, arousal and aversion disorders. The provider might want to ask some of the follow-up questions in order to help them and their patients distinguish between primary concerns. Once they have more accurately clarified issues, they may discuss making an appropriate referral.

Once you start having sex, is your body responding?
- No, indicates a problem with arousal that can be an independent problem or can be the primary problem resulting in low desire
If, when you had sex, the sex itself was “good” and satisfying, would you want to have sex again?
- Yes, indicates the likelihood that the problem may be arousal rather than desire
- If the patient responds that the quality of sex is good but she still has no interest in repeating the experience, then she is describing a clear lack of desire
Is your disinterest in sex universal? Or are you interested in sex with other people, but not necessarily your partner?
When was the last time you had sex? If over a month, ascertain if that is due to circumstances, their partner’s disinterest or their disinterest
Consider administering the Female Sexual Functioning Index (FSFI)
- A score of 6 or lower in the desire domain suggests a diagnosis of low desire

SYNOPSIS:

Women’s sexual concerns are often interlinked. A woman can become avoidant of sex because of a lack of an arousal response or because of pain she experiences, or she can be disinterested or avoidant, independent of other issues. Any or all of these can be overlapping, and because colloquial descriptions of problems do not necessarily match clinical diagnosis, it is important to distinguish between various concerns in order to provide appropriate support, referral and treatment.

KEY POINTS:

It is critical for the clinician to differentiate wherever possible between sexual concerns despite the fact that the patient may be unable to do so for herself.

Arousal disorders describe an inability to get excited or respond during sexual activity.
- Women will complain of not getting “fluttery, wet, tingly or turned on.” Or they will complain of a lag time where it “takes forever” to get “turned on”
- Generally, this is comorbid with orgasmic problems but not always
- Problems with arousal can be easily confused with desire issues, but they are different problems and may need to be treated differently
Pure desire problems describe a lack of interest in sexual activity even when the sex itself was satisfying and orgasm is easily achieved
While these two problems often overlap, they may be treated differently. Helping your patient understand the difference will be helpful in providing support and referrals

Learn More – Primary Sources:

Sexual desire and the female sexual function index (FSFI)

ACOG Practice Bulletin 213: Female Sexual Dysfunction

AAFP: Sexual Dysfunction in Women – A Practical Approach

ISSWSH Expert Consensus Panel Review: Hypoactive Sexual Desire Disorder

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