065IC - Urologic Management of Female Sexual Dysfunction

Sunday, April 30, 2023

1:30 PM – 3:30 PM CST

Location: S105A

Instructional Course Director(s)

Irwin Goldstein, Dr. (he/him/his)

Director of Sexual Medicine
University of California San Diego

Instructional Course Faculty(s)

Noel Kim, PhD

Senior Investigator
Institute for Sexual Medicine
Rachel Rubin, MD (she/her/hers)

Assistant clinical professor in Urology
Georgetown University Hospital
Alyssa Yee, MD (she/her/hers)

Urologist and Sexual Medicine Physician
San Diego Sexual Medicine/Scripps Clinic

Course Description: This course will teach the urologist and advanced practice provider the skills needed to better communicate with patients with vulvas about their sexual health needs and better manage their sexual dysfunctions. The course will start with normal physiology of function and pathophysiology of dysfunction of the genitals including how to examine them under magnification in order to better understand sexual dysfunctions in people with vulvas. Diagnostic tools and treatment strategies for the management of desire, arousal, orgasm and pain disorders, including unusual arousal/orgasm issues such as persistent genital arousal disorder/genitopelvic dysesthesia, will be discussed. Included in this course is an overview of how to use the latest U.S. Food and Drug Administration-approved drugs, off-label options, devices such as CO2 fractional laser and surgical therapies. People with distressing sexual health concerns should undergo biopsychosocial diagnostic evaluations to assess pathophysiology, starting with a history and physical including vulvoscopy. Videos will show how to perform a vulvoscopy and pelvic floor assessment. Risks and benefits of hormone therapy for pre- and post-menopausal women will be discussed, including practical information on how to prescribe vaginal estrogen in menopause. In addition, information about neurological issues affecting sexual function will be presented. Also discussed are risk factors for female sexual dysfunction and comorbid conditions such as genitourinary syndrome of menopause, interstitial cystitis/recurrent urinary tract infections and sexual dysfunction, clitoral phimosis and previous genital surgeries including mid urethral slings. People with vulvas presenting with urological concerns may, in fact, have sexual dysfunction as the primary issue. This content is especially important for the urologist who treats sexual dysfunction in the male partner in a heterosexual couple, as the female partner may have concomitant sexual problems that need to be addressed.

Learning Objectives:

Associate basic science principles with physiology and pathophysiology of sexual function and dysfunction in people with vulvas.
Apply principles of history and physical examination to people with vulvas with sexual dysfunction.
Characterize the consensus paradigms for identification of sexual problems in people with vulvas, including hypoactive sexual desire disorder, and persistent genital arousal disorder/genital pelvic dysesthesia developed by the International Society for the Study of Women’s Sexual Health.
Diagnose and treat people with vulvas with sexual dysfunction presenting in a community setting with U.S. Food and Drug Administration-approved and off-label medical therapies including estrogen (and progesterone) and androgen therapies as well as centrally acting drugs.
Identify when sexual pain should be treated surgically.