Diagnosing Sexual Dysfunction in Men and Women: Sexual History Taking and the Role of Symptom Scales and Questionnaires

doi:10.1016/j.jsxm.2016.05.017

The Journal of Sexual Medicine

Volume 13, Issue 8, August 2016, Pages 1166-1182

https://doi.org/10.1016/j.jsxm.2016.05.017 Get rights and content

Abstract

Introduction

A detailed sexual history is the cornerstone for all sexual problem assessments and sexual dysfunction diagnoses. Diagnostic evaluation is based on an in-depth sexual history, including sexual and gender identity and orientation, sexual activity and function, current level of sexual function, overall health and comorbidities, partner relationship and interpersonal factors, and the role of cultural and personal expectations and attitudes.

Aim

To propose key steps in the diagnostic evaluation of sexual dysfunctions, with special focus on the use of symptom scales and questionnaires.

Methods

Critical assessment of the current literature by the International Consultation on Sexual Medicine committee.

Main Outcome Measures

A revised algorithm for the management of sexual dysfunctions, level of evidence, and recommendation for scales and questionnaires.

Results

The International Consultation on Sexual Medicine proposes an updated algorithm for diagnostic evaluation of sexual dysfunction in men and women, with specific recommendations for sexual history taking and diagnostic evaluation. Standardized scales, checklists, and validated questionnaires are additional adjuncts that should be used routinely in sexual problem evaluation. Scales developed for specific patient groups are included. Results of this evaluation are presented with recommendations for clinical and research uses.

Conclusion

Defined principles, an algorithm and a range of scales may provide coherent and evidence based management for sexual dysfunctions.

Introduction

Committee 3 of the International Consultation on Sexual Medicine (ICSM) reviewed a large body of relevant publications on the diagnostic evaluation of sexual function in men and women, including advances in specialized testing for women and men and the development of scales and questionnaires for evaluating sexual dysfunction (SD) in women and men. We report the findings and recommendations of the committee for the overall diagnostic approach and assessment algorithm for evaluation of male and female SDs and the use of symptom scales and questionnaires in particular to assist in the evaluation. The committee also considered current scientific and regulatory requirements for the development and validation of patient-reported outcomes (PROs) and cultural and clinical considerations when using these assessments.

Section snippets

Principles of Sexual Medicine

The committee endorses three basic principles for clinical evaluation and management of sexual problems in men and women. These are briefly as follows:

Principle 1—adoption of a patient-centered framework, with emphasis on cultural competence in clinical practice
Principle 2—application of evidence-based principles in diagnostic and treatment planning
Principle 3—use of a similar management framework for men and women

When taken together, these three principles provide a balanced and integrated

Part 2. Questionnaires and symptom scales for sexual problem assessment

Broadly speaking, two different self-report measurements have been developed for SD: (i) screening checklists that provide clinicians and researchers with an indication of whether patients are experiencing sexual problems and (ii) multidimensional questionnaires that provide more in-depth evaluation of the patient’s current sexual function and/or sexual well-being. This section provides readers with an overview of commonly used scales and questionnaires, including their major strengths and

Conclusion

1.
Self-report questionnaires and symptom scales provide a valuable adjunct to clinical care or outcomes research in male and female SD. However, these measurements should not be used as a substitute for face-to-face clinical interaction with the patient or detailed sexual history taking.
2.
Multiple scales and questionnaires have been reviewed in this article (Table 1). Strengths and limitations of each measurement have been evaluated.
3.
Strengths include standardized and efficient measurement of

Statement of authorship

Category 1

(a)
Conception and Design
- D. Hatzichristou; P.S. Kirana; L. Banner; S. Althof; R. Lonnee-Hoffman; L. Dennerstein; R. Rosen
(b)
Acquisition of Data
- D. Hatzichristou; P.S. Kirana; L. Banner; S. Althof; R. Lonnee-Hoffman; L. Dennerstein; R. Rosen
(c)
Analysis and Interpretation of Data
- D. Hatzichristou; P.S. Kirana; L. Banner; S. Althof; R. Lonnee-Hoffman; L. Dennerstein; R. Rosen

Category 2

(a)
Drafting the Article
- D. Hatzichristou; P.S. Kirana; L. Banner; S. Althof; R. Lonnee-Hoffman; L. Dennerstein; R. Rosen
(b)
Revising It for

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Septal myectomy improves symptoms in the majority of patients with obstructive hypertrophic cardiomyopathy (HCM), but there are limited prospective data on functional outcomes after operation.
The authors investigated quality of life measures and prevalence of sexual dysfunction before and after septal myectomy for obstructive HCM.
Between January 2018 and October 2019, 436 patients underwent transaortic septal myectomy at our clinic. All patients were screened for eligibility, and 197 (45.2%) were enrolled in this prospective survey study. Patients received a questionnaire pertaining to quality of life and sexual health before and within 4 to 6 months postoperatively, and 113 (57.4%) completed the follow-up survey.
The mean age of the 54 (47.8%) women and 59 (52.2%) men was 54.7 ± 14.1 years. Quality of life, including both mental and physical components, improved significantly in both men (P < 0.001) and women (P < 0.001). Women reported mild sexual dysfunction at baseline, and following septal myectomy, they experienced significant (P < 0.05) improvement in most domains pertaining to sexual health. In men, the International Index of Erectile Function median score was 23 (IQR: 7.0-29.5), which is consistent with mild dysfunction at baseline, and there was significant improvement following surgery in young (age ≤55 years) men (P < 0.001).
Quality of life is significantly improved following septal myectomy in patients with obstructive HCM. Both women and men reported mild sexual dysfunction at baseline, and women and younger men (age ≤55 years) experienced significant improvements in sexual health.
Management of erectile dysfunction and premature ejaculation: The perspective of Spanish urologists. Results of the PANDORA Project (Part II)
2023, Revista Internacional de Andrologia
ED and PE are the most common male sexual dysfunctions, although they remain underdiagnosed and undertreated.
To ascertain how a group of Spanish urologists currently address ED and PE.
Descriptive study based on a self-designed questionnaire about the clinical practice in ED and PE upon diagnosis, treatment and monitoring, patient–physician relationship and the role of the patient's partner.
The survey was completed by 188 experienced urologists. Most patients went to the urologist's office without a previous diagnosis (92% of the urologists found <10 PE-diagnosed patients in public settings). The diagnosis of ED and/or PE was mainly carried out by the current urologist and not by another professional, particularly in private centres as opposed to public centres (78.8% vs 57.0% for ED; 82.0% vs 62.6% for PE). Most urologists believed that these disorders are underdiagnosed and deemed them as general health issues. 38% of urologists acknowledged using validated questionnaires to diagnose ED. PE was considered a subjective problem rather than a true disease and the use of PRO-based diagnosis of PE was not generally accepted (14%). Treatment options of both disorders were chosen as expected. Referral to the andrologist is usually scheduled in moderate-to-severe PE or severe ED. The cohort seemed to be mostly neutral (50%–75% for ED and 40%–55% for PE) regarding patient reluctancy to talk about their sexual problem. Patients’ partners play an important role in helping men seeking treatment.
Urologists should show more proactivity during anamnesis and routine visits to improve management of ED and PD.
A pesar de que, la DE y la EP son las disfunciones sexuales masculinas más frecuentes, siguen estando infradiagnosticadas e infratratadas.
Conocer cómo es el abordaje actual de la DE y la EP, a partir de un grupo de urólogos españoles.
Estudio descriptivo, mediante un cuestionario predefinido, con relación a la práctica clínica de la DE y la EP, incluyendo su diagnóstico, su tratamiento y su seguimiento, la relación médico-paciente y el papel de la pareja.
Ciento ochenta y ocho urólogos expertos dieron respuesta al cuestionario predefinido. La mayoría de los pacientes acudieron a la consulta del urólogo sin un diagnóstico previo (el 92% de los urólogos hallaron <10 pacientes diagnosticados de PE en el ámbito público). El diagnóstico de la DE y/o la EP fue realizado mayoritariamente por el urólogo, y no por otro profesional, especialmente en el ámbito privado frente al público (78,8 frente al 57,0% para la DE; 82,0 frente al 62,6% para la EP). La gran mayoría de los urólogos señalaron que ambas disfunciones estaban siendo infradiagnosticadas y, por tanto, las consideraron como un problema de salud general. El 38% de los urólogos indicó utilizar cuestionarios validados para el diagnóstico de la DE. La EP se percibió como un problema subjetivo más que como una verdadera enfermedad, y el uso de PRO en el diagnóstico de la EP no fue generalmente aceptado (14%). La elección de las opciones de tratamiento de ambas disfunciones aconteció según lo esperado. Se consideró la derivación a andrología en los casos de la EP moderada-grave o en los casos de la DE grave. En cuanto a la reticencia de los pacientes a hablar de su problema sexual, la respuesta fue mayoritariamente neutra (50-75% para la DE y 40-55% para la EP). Las parejas de los pacientes desempeñan un papel importante en el momento que estos buscan opciones de tratamiento.
Los urólogos deben mostrar mayor proactividad, durante la anamnesis y las visitas de rutina, para mejorar el manejo de la DE y la EP.
How to explore and explain autonomic changes in multiple sclerosis
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Autonomic dysfunction (AD) in people with MS (pwMS) is a frequent finding. This narrative review will present an overview of central neural mechanisms involved in the control of cardiovascular and thermoregulatory systems, and methods of autonomic nervous system testing will be discussed thereafter. Since the need for standardization of autonomic nervous system (ANS) testing, we will focus on the standard battery of tests (blood pressure and heart rate response to Valsalva maneuver and head-up tilt, and heart rate response to deep breathing test plus one of the tests for sudomotor function), which can detect ANS pathology in the majority of pwMS. The review will briefly discuss the other types of AD in pwMS and the use of appropriate tests. While performing ANS testing in pwMS one has to consider the multiple sclerosis phenotypes, disease duration, and its activity, the degree of clinical disability of patients included in the study, and the disease-modifying therapies taken, as these factors may have a great influence on the results of ANS testing. In other words, detailed patient characteristics presentation and patient stratification are beneficial when reporting results of ANS testing in pwMS.
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Nous recommandons de donner à tous les patients atteints d’EP des conseils psychosexologiques et, chaque fois que possible, associer les pharmacothérapies et les thérapies cognitivo-comportementales centrées sur la sexualité, en impliquant la.le partenaire dans le processus de traitement. D’autres approches sexologiques pourraient être utiles. Nous recommandons l’utilisation de la dapoxétine comme traitement oral de première ligne, à la demande, pour l’EP primaires et acquises. Nous recommandons l’utilisation de la lidocaïne 150 mg/mL/prilocaïne 50 mg/mL en spray, comme traitement local pour les EP primaires. Nous suggérons l’association de la dapoxétine et de la lidocaïne/prilocaïne chez les patients insuffisamment améliorés par la monothérapie. Chez les patients n’ayant pas répondu aux traitements ayant une AMM, nous suggérons d’utiliser un ISRS hors AMM, de préférence la paroxétine, en l’absence de contre-indication. Nous recommandons de traiter la DE avant l’EP chez les patients présentant les deux symptômes. Nous ne recommandons pas d’utiliser les α-1 bloquants, ni le tramadol chez les patients atteints d’EP. Nous ne recommandons pas la réalisation systématique d’une posthectomie ou d’une chirurgie du frein du pénis pour une EP.
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: Conflict of Interest: The authors report no conflicts of interest.

: Funding: None.

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International Consultation on Sexual Medicine ReportDiagnosing Sexual Dysfunction in Men and Women: Sexual History Taking and the Role of Symptom Scales and Questionnaires

Abstract

Introduction

Aim

Methods

Main Outcome Measures

Results

Conclusion

Introduction

Section snippets

Principles of Sexual Medicine

Part 2. Questionnaires and symptom scales for sexual problem assessment

Conclusion

Statement of authorship

J Sex Med

J Sex Med

J Sex Med

J Sex Med

J Sex Med

J Sex Med

J Urol

J Sex Med

Maturitas

J Sex Med

J Sex Med

J Sex Med

J Sex Med

Sex Med

J Sex Med

J Sex Med

Urology

Eur Urol

Urology

Urology

J Sex Med

J Sex Med

J Sex Med

J Sex Med

Urology

Int J Radiat Oncol Biol Phys

J Sex Med

Am J Obstet Gynecol

J Sex Med

Schizophr Res

J Urol

J Sex Med

J Sex Med

J Sex Med

J Sex Med

J Sex Med

Urology

Urology

Value Health

J Sex Med

J Sex Med

Eur Urol

J Sex Med

International Consultation on Sexual Medicine Report
Diagnosing Sexual Dysfunction in Men and Women: Sexual History Taking and the Role of Symptom Scales and Questionnaires