الفهرس 
INTRODUCTION
Physiology of Female Sexual Function (FSF)Only 14 pages are availabe for public view
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Abstract
Despite the high prevalence of Female Sexual Dysfunction (FSD) disorders these problems frequently go undetected, undiagnosed and ill managed in primary health care (PHC) services. FSD is a multicausal and multidimensional problem combining biological, psychological and interpersonal determinants. This dysfunction greatly impacts women’s sense of well-being, interpersonal relationships and quality of life. The etiology of sexual dysfunction is frequently multifactorial as it relates to general physical and mental well- being, quality of relationship, past sexual functioning, social class, education, employment, life stressors, personality factors, the presence of a sexual partner, and partner’s age and health. Diagnosis of sexual dysfunction and its causes is based on history and physical examination.
Primary care physicians are the first point of contact for most patients with sexual difficulties. They can effectively address sexual health with their female patients. They can manage less complex problems. Competence in taking a sexual history, eliciting sexual problems from patients, assessing, treating, and educating patients regarding sexual disorders is essential to practicing physician.
This study aimed to study knowledge, attitude, and practices of PHC physicians regarding FSD. Do they have the enough and updating knowledge about the physiology of the Female Sexual Response Cycle (FSRC) and FS? What are their attitudes, and practices in screening and management of FSD? What barriers they perceive to deal with sexual disorders? and what are their suggestions to improve the current situation?
Study settings:
The study was conducted in primary health care units and centers (n=115) including the following: family planning (F.P) clinics affiliated to family health units/centers, Maternal and Child Health centers and in the specialized obstetrics and gynecological clinics affiliated to family health centers in Alexandria.
Study design and population:
It was a cross section study and the target population was family physicians and Obs.
/Gyn. specialists working in the aforementioned health units and centers. Verbal consent was taken from the physicians, 220 questionnaires were distributed to physicians in all the primary health care units and centers in their clinics and 200 completed were returned. Response rate was (91%).
Data collection:
A self-administered predesigned questionnaire (comprised 79 questions) was used to collect the following data:
-Personal data such as age, sex, marital status, data about education and work: highest academic degree, years of experience including years of work since graduation, years of work in PHC, average patients per day, etc.
-Physicians’ knowledge about: Female sexual response cycle, different types of FSD in different life stages, prevalence of FSD, screening and management of FSD.
-Physicians’ beliefs and attitude regarding screening and management of FSD.
-Physicians’ reported practices concerning screening and management of FSD as compared to the evidence-based clinicians’ guidelines.
- Barriers perceived by health care providers that may hinder appropriate screening and management of FSD and their suggestions for improving service.
Data analysis:
-Data were analyzed using SPSS program version 16 (PASW). The Chi squared test was used to test the association between knowledge, attitude, practice and the sociodemographic data. Differences were considered significant at p values < 0.05.
The main results of the study are summarized as follows:
• The mean age of participants was 38.18 year, most of the physicians were females (98%), about half (43.5%) were F.P specialists, and 46.5% had diploma degree.
•Most of the physicians (91.5%) had attended at least one training course (F.P. & reproductive health (R.H.).
• Only 32.5% had high level of knowledge; all of them had good knowledge about the main features of female sexual response cycle (FSRC). They had poor knowledge about the physiology of FSRC. Only 40% had a correct answer about the medical conditions and its effect on sexual function.
•As regard attitude, a small number of the physicians (1%) reported favorable attitude and 74.5% had neutral attitude toward screening and management of FSD.
•Most of them (87.5%) had positive attitude toward that sexual health should be included in routine history taking and 83.5% of them had favorable attitude toward seeking additional training for health care provider who lack confidence in taking bio- psychosocial approach to counseling on sexual health concerns.
•More than three quarters (76%) had positive attitude toward including a question about sexual history in the file of family health as a better screening method. Two thirds of the participants (67.5%) had positive attitude toward “genital examination is essential for evaluation of women complaint of FSD but general examination is not important for the evaluation of women complaint”.
•About half (49.5%) had negative attitude toward that “the main role of family physician in management of FSD is referral” to the appropriate specialist”, and also half of them (48%) had negative attitude toward, “it would be very difficult for a physician to apply screening procedures for FSD because of high patient rate”. Less than half of them (43.5%) agreed that physicians should initiate discussion about the sexual health.
•Regarding beliefs, 72% of them believed that asking about sexual health takes a lot of time. It is like opening a box full of worms, once opened, it is difficult to be closed. Nearly half (43%) believed that people no longer engage in sex after a certain age (e.g., a patient who states, “I haven’t had an orgasm in 7 years, but I’m 42 and so… that is to
be expected”. More than one third (40%) of participants had wrong beliefs about that
patients don’t want health care providers to inquire about sexual health.
•The sampled physicians divided into 2 categories as in relation to their practices 53% had fair practices, 45.5% had good practices, and only 1.5% reported bad practice, and the most frequent practices done by the physicians was recommending the use of lubricant or estrogen for problems arising from vaginal dryness.
• Only about one third (30%) of the physicians help women deal with their concerns related to breastfeeding and sexual activity. This includes providing reassurance about the hormonal causes of erotic feelings during breastfeeding. One quarter (27%) of the participant frequently communicate to their patients that they are open to discussing sexual concerns and educate them about normal sexual practices.
• More than half of the physicians (60%) rarely discuss safer sex, have referral list, or include screen question regarding sexual wellbeing.
• Those who reported good practices were more likely to be practicing less than 2 years.
•The deficiency of knowledge was reported by the physicians as the main barriers that hinder the appropriate screening and management of FSD followed by lack of privacy between doctor and patient, and lack of training in sexual education area. (70%, 53%, and 43% respectively).
•Also 44% reported need for training, 30% provide lack of time as a barrier, 28% reported no place to referral, 27% no simple tool of screening, 26.5% no treatment available, 26% need a specialist to handle, while only 3.5% of the physicians reported that they have no barrier.
• Physician reported certain suggestion to improve the service. The vast majority of the physicians (80.0%) reported that they need training courses to improve the current situation of screening and management of female sexual dysfunction, about one quarter (23.5%) need simple tool for screening, while only 4% of them reported that good communication can improve the service.
•When asked about their perception of self-confidence in management of FSD, the majority of the physicians (71.5%) perceived that they have some knowledge and skills to manage FSD but they need training.
Based on the results, the recommendations were:
•Providing training courses to the physicians in primary care units to give updating knowledge about Female Sexual Function and FSD.
•Development of academic curricula to provide practicing physicians across specialties with the needed skills to meet contemporary patients’ needs in sexual medicine health- care delivery.
•Providing communication skills training courses to improve physician′s attitude to
initiate discussion about the sexual function.
• Sexual education should be an essential part of any family planning or reproductive health training courses.
• Health education about the normal sexual function and dysfunction that may occur during pregnancy should be a part of the information given to each woman during their antenatal care visit.
•Placing flyers or booklets containing sexual information in the family planning clinics.
•For improving the service a simple screening tool must be available in the primary care centers and family planning clinics (e.g. Decreased Sexual Desire Screener (DSDS) or PLISST).
• Private clinics in family medicine centers can be utilized to provide sexual services to women with sexual concern.
• Routine assessment of sexual functioning needs to be integrated into ongoing care to identify and address problems early.
•Screening for sexual complaints should be part of a medical assessment.