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Mayo Clin Proc. 2019 May;94(5):842-856. doi: 10.1016/j.mayocp.2019.01.009. Epub 2019 Apr 4.

The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women.

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Department of Medicine and Department of Psychiatry, Weill Cornell Medical College, New York, NY. Electronic address:
Department of OB/GYN, Albert Einstein College of Medicine, Bronx, NY.
San Diego Sexual Medicine, San Diego, CA.
Department of Clinical Medicine and Department of Family and Community Medicine, Sexological Clinic, Psychiatric Center Copenhagen, University of Copenhagen, Denmark.
Department of OB/GYN, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH.
Lisa Larkin MD and Associates, Cincinnati, OH.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
University of Toronto, ON, Canada.
Park Nicollet Sexual Medicine and Male Infertility, St. Louis Park, MN.
Novant Health Mintview Ob/Gyn, Charlotte, NC.
Department of Psychology and Division of General Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY.
Center for Women's Health and Division of General Internal Medicine, Mayo Clinic, Rochester, MN.


Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.

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