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Gap in Sexual Dysfunction Management Between Male and Female Patients Seen in Primary Care: An Observational Study
Open accessAbstract
Background: 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. Objective: To describe differences in patterns of FSD and ED diagnosis and management in primary care patients. Design: Retrospective observational study. Subjects: Primary care patients with an incident diagnosis of FSD or ED seen at a large, integrated health system between 2016 and 2022. Main Measures: 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. Key Results: 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. Conclusions: 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. Graphical abstract:
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There are knowledge gaps in PCPs when compared to specialists in other common conditions, such as sexual dysfunction and HLD management.
“There are knowledge gaps in PCPs when compared to specialists in other common conditions, such as sexual dysfunction and HLD management.13,14”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [13]
The Background says PCPs report feeling underprepared to manage female sexual dysfunction, and the Conclusion reports fewer management orders for those patients when diagnosed by PCPs than by OB/GYNs. The study does not establish that a knowledge gap causes this difference; it also finds that PCPs order erectile-dysfunction management more often than urologists. HLD management appears to be attributed to the other citation and is not assessed here. (LLM, conf=0.85)
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Sexual Problems and Distress in United States Women: Prevalence and Correlates
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Hurt, R. T., Stephenson, C. R., Gilman, E. A., Aakre, C. A., Croghan, I. T., Mundi, M. S., Ghosh, K., & Edakkanambeth Varayil, J. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251332215 · Cited by 78
“13,14 Despite these knowledge differences, to date, most AI CDM tools have been focused on specific organ or disease problems because of the narrower data elements (i.e., liver enzymes and imaging) needed for the LLMs compared to the undifferentiated nature of PCC patients.”
Metadata
- Authors
- Stanley, E. E., Pfoh, E., Lipold, L., & Martinez, K.
- Affiliations
- Cleveland Clinic Lerner College of Medicine (US)
- Cleveland Clinic (US)
- Corresponding author
- Stanley, Elizabeth E.
- Venue
- Journal of General Internal Medicine
- Published
- 2024-09-04
- Volume
- 40
- Issue
- 4
- Pages
- 847-853
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC11914646
- OpenAlex
- W4402223210
- Cited by
- 9
- References
- 2
- Citations by year
- 2026: 3 · 2025: 6
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- female sexual dysfunction, erectile dysfunction, sexual dysfunction management, primary care, guideline-concordant care, physician specialty, urologists, health care disparities, drug prescribing
- MeSH terms
- Adult, Aged, Female, Humans, Erectile Dysfunction, Male, Middle Aged, Practice Patterns, Physicians', Primary Health Care, Retrospective Studies, Sexual Dysfunction, Physiological, Sexual Dysfunctions, Psychological
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