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Having the Sexual Dysfunction Discussion Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Nevertheless, the author, editors, and publisher can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The author, editors, and publisher therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. PUBLISHED BY NEI PRESS, an imprint of NEUROSCIENCE EDUCATION INSTITUTE Carlsbad, California, United States of America NEUROSCIENCE EDUCATION INSTITUTE 1930 Palomar Point Way, Suite 101 Carlsbad, California 92008 http://www.neiglobal.com Copyright © 2009 Neuroscience Education Institute. All rights reserved. This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Neuroscience Education Institute. Printed in the United States of America First Edition, February 2010 Typeset in Myriad Pro Library of Congress Cataloging-in-Publication Data ISBN 1-4225-0082-9 Table of Contents CME Information................................................................................................ i Section 1: The Evolution of the Classification of Female Sexual Dysfunction............................................................................................ 1 Section 2: The Neurobiology of Female Sexual Dysfunction............. 9 Section 3: Facilitating Patient-Physician Communication................... 25 Section 4: Sexual Questionnaires, Rating Scales, and Patient-Reported Outcomes.......................................................................... 35 Section 5: Treatments for Female Sexual Dysfunction......................... 49 Summary............................................................................................................... 57 References............................................................................................................. 59 Appendix............................................................................................................... 61 CME Posttest and Activity Evaluation......................................................... 65 Having the Sexual Dysfunction Discussion CME Information Overview The aim of this booklet is to explain the underlying pathophysiology of hypoactive sexual desire disorder (HSDD), to increase physician awareness, to facilitate patient-physician and physician-patient communication, and to present the treatment options available. Section 1 explains the female sexual response cycle and how sexual desire disorder has been classified in the various Diagnostic and Statistical Manual of Mental Disorders volumes. Section 2 explains the neurobiology of female sexual dysfunction and the role of the brain in this disorder. Section 3 explains the reasons underlying the patient-physician miscommunication, and Section 4 provides tools to physicians to facilitate discussion and diagnosis of hypoactive sexual desire disorder. Section 5 introduces the general treatments, either approved or in clinical trials, for hypoactive sexual desire disorder. Target Audience This CME activity has been developed for primary care physicians, gynecologists, nurse practitioners, and psychiatrists. Statement of Need The following unmet needs regarding female sexual dysfunction were revealed following a literature review and through new medical knowledge: • Increasing clinici