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国际女性性健康学会女性性欲低下管理关怀流程。

The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women.

机构信息

Department of Psychiatry and Neurobehavioral Sciences and Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA.

Sexual Medicine Program, Alvarado Hospital, San Diego, CA.

出版信息

Mayo Clin Proc. 2018 Apr;93(4):467-487. doi: 10.1016/j.mayocp.2017.11.002. Epub 2018 Mar 12.

Abstract

The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.

摘要

国际女性性健康学会(ISSWSH)制定了关注女性性欲障碍(HSDD)管理的流程(POC)算法,旨在为医疗保健专业人员提供诊断和治疗 HSDD 的循证指南。HSDD 影响 10%的成年女性,与负面情绪和心理状态以及包括抑郁在内的医学状况有关。该算法使用改良 Delphi 法制定,以达成 17 位代表多个学科的国际小组成员的共识。POC 从医疗保健专业人员询问性关注开始,重点关注与低性欲/兴趣相关的问题。诊断包括区分全身性获得性 HSDD 和其他形式的低性兴趣。对潜在可改变因素的生物心理社会评估有助于通过教育开始治疗、修改潜在可改变因素,如果需要,还可以进行额外的治疗干预:性治疗、中枢神经系统药物和激素治疗,部分由绝经状态指导。性治疗包括行为治疗、认知行为治疗和正念。目前,美国食品和药物管理局(FDA)唯一批准用于 HSDD 的中枢神经系统药物是氟班色林,适用于绝经前 HSDD 女性;在绝经后 HSDD 女性中使用氟班色林的数据支持,但未经 FDA 批准。激素治疗包括 HSDD 绝经后女性的睾酮的标签外使用,这得到了数据的支持,但未经 FDA 批准。POC 包括监测治疗进展。总之,国际女性性健康学会(ISSWSH)管理 HSDD 妇女的 POC 为医疗保健专业人员提供了管理适当评估和个体化治疗患者的合理、循证指南。

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