Stanley Elizabeth E, Pfoh Elizabeth, Lipold Laura, Martinez Kathryn
Cleveland Clinic Lerner College of Medicine, Cleveland, USA.
Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA.
J Gen Intern Med. 2025 Mar;40(4):847-853. doi: 10.1007/s11606-024-09004-1. Epub 2024 Sep 4.
Female sexual dysfunction (FSD), defined as clinically distressing problems with desire, arousal, orgasm, or pain, affects 12% of US women. Despite availability of medications for FSD, primary care physicians (PCPs) report feeling underprepared to manage it. In contrast, erectile dysfunction (ED) is frequently treated in primary care.
To describe differences in patterns of FSD and ED diagnosis and management in primary care patients.
Retrospective observational study.
Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022.
Sexual dysfunction management (referral or prescription of a guideline-concordant medication within 3 days of diagnosis), patient characteristics (age, race, insurance type, marital status), and specialty of physician who diagnosed sexual dysfunction. We estimated the odds of FSD and ED management using mixed effects logistic regression in separate models.
The sample included 6540 female patients newly diagnosed with FSD and 16,591 male patients newly diagnosed with ED. Twenty-two percent of FSD diagnoses were made by PCPs, and 38% by OB/GYNs. Forty percent of ED diagnoses were made by PCPs and 20% by urologists. Patients with FSD were managed less frequently (33%) than ED patients (41%). The majority of FSD and ED patients who were managed received a medication (96% and 97%, respectively). In the multivariable models, compared to diagnosis by a specialist, diagnosis by a PCP was associated with lower odds of management for FSD patients (aOR, 0.59; 95% CI, 0.51-0.69) and higher odds of management (aOR, 1.52; 95% CI, 1.36-1.64) for ED patients.
Primary care patients with FSD are less likely to receive management if they are diagnosed by a PCP than by an OB/GYN. The opposite was true of ED patients, exposing a gap in the quality of care female patients receive.
女性性功能障碍（FSD）被定义为在性欲、性唤起、性高潮或性交疼痛方面存在临床上令人苦恼的问题，影响着12%的美国女性。尽管有治疗FSD的药物，但初级保健医生（PCP）表示在管理该疾病方面准备不足。相比之下，勃起功能障碍（ED）在初级保健中经常得到治疗。
描述初级保健患者中FSD和ED诊断与管理模式的差异。
回顾性观察研究。
2016年至2022年期间在一个大型综合医疗系统中首次被诊断为FSD或ED的初级保健患者。
性功能障碍管理（在诊断后3天内转诊或开具符合指南的药物处方）、患者特征（年龄、种族、保险类型、婚姻状况）以及诊断性功能障碍的医生专业。我们在单独的模型中使用混合效应逻辑回归估计FSD和ED管理的几率。
样本包括6540名新诊断为FSD的女性患者和16591名新诊断为ED的男性患者。22%的FSD诊断由初级保健医生做出，38%由妇产科医生做出。40%的ED诊断由初级保健医生做出，20%由泌尿科医生做出。FSD患者接受管理的频率（33%）低于ED患者（41%）。大多数接受管理的FSD和ED患者都接受了药物治疗（分别为96%和97%）。在多变量模型中，与专科医生诊断相比，初级保健医生诊断与FSD患者管理几率较低相关（调整后比值比[aOR]，0.59；95%置信区间[CI]，0.51 - 0.69），而与ED患者管理几率较高相关（aOR，1.52；95% CI，1.36 - 1.64）。
如果初级保健患者的FSD是由初级保健医生而非妇产科医生诊断的，那么他们接受管理的可能性较小。ED患者则相反，这暴露了女性患者所接受护理质量方面的差距。
