REFERENCES 1. Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol 2015;125:477–86. 2. Sobecki JN, Curlin FA, Rasinkski KA, Lindau ST. What we don’t talk about when we don’t talk about sex: results of a national survey of U.S. obstetrician/gynecologists. J Sex Med 2012;9: 1285–94. 3. Staton A, Kurian A, Cobb K, Mills MA, Ford JM. Cancer risk reduction and reproductive concerns in female BRCA1/2 mutation carriers. Fam Cancer 2008;7:179–86.
In Reply: The authors thank Lindau et al for bringing attention to the role that cancer and its prevention or treatment plays in women’ s sexuality and sexual wellbeing. Cancer-related sexual dysfunction is an important quality-of-life issue; sexual health is one of eight areas covered by the National Comprehensive Cancer Network Guidelines for survivorship, which recommend that providers screen patients for sexual problems at regular intervals from the time of cancer diagnosis through the balance of their lives.1 Indeed, cancer can affect all domains of sexual functioning in complex ways.2 This highlights the importance of asking all women about sexual concerns and being open-minded about the effects that coexisting medical conditions, including cancer, can have on sexual function. In addition to the biological and psychological factors that influence libido, women with cancer may also experience changes in relationship dynamics with an intimate partner (who is also often a caregiver) that might negatively affect desire.3 Our review4 is intended to provide a general overview of the diagnosis and treatment of low desire in women, and we agree that the potential consequences of cancer and its prevention and treatment should be considered when evaluating a woman with this complaint. Given the myriad ways that sexual function and well-being can be affected in women with any cancer type, we believe that this topic warrants a separate and more thorough review. Financial Disclosure: Dr. Kingsberg is a consultant or sits on advisory boards for Sprout, Palatin, Pfizer, Shionogi, Trimel, Apricus, Strategic Solutions Technology, Nuelle, NovoNordisk, Metagenics, Emotional Brain, Endoceutics, Sermonix, and Teva. The other author did not report any potential conflicts of interest.
1496
Letters
Sheryl A. Kingsberg, PhD University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio Terri Woodard, MD The University of Texas MD Anderson Cancer Center and Baylor College of Medicine, Houston, Texas
REFERENCES 1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: survivorship (version 1.2015). Available at: http:// www.nccn.org/professionals/physician_gls/ pdf/survivorship.pdf. Retrieved February 27, 2015. 2. DeSimone M, Spriggs E, Gass JS, Carson SA, Krychman ML, Dizon DS. Sexual dysfunction in female cancer survivors. Am J Clin Oncol 2014;37: 101–6. 3. Rolland J. In sickness and in health: the impact of illness on couples’ relationships. J Marital Fam Ther 1994;20: 327–47. 4. Kingsberg SA, Woodard T. Female sexual dysfunction. Focus on low desire. Obstet Gynecol 2015;125:477–86.
be their normal state. I believe that our failure to recognize that lack of desire can be a normal variant in the spectrum of sexual response leads to much of the personal distress creating the diagnosis of sexual dysfunction. Homosexuality was once considered a disorder by the DSM, with societal disapproval creating much “personal distress” in those “suffering from” this disorder. The Asexual Visibility and Education Network seeks to educate the public that there are individuals who do not experience sexual attraction and those who have little interest in sex (most for their entire lives) and that these individuals can still lead happy, productive lives and experience fulfilling relationships. Additionally, the fact that a phone survey by West et al3 revealed an incidence of low sexual desire of more than 50% in naturally postmenopausal women in 2008 emphasizes that decrease in sexual desire is a normal part of aging for women. It can be therapeutic to counsel that lack of desire is not necessarily pathologic. Financial Disclosure: The author did not report any potential conflicts of interest.
Female Sexual Dysfunction: Focus on Low Desire To the Editor: I appreciated Drs. Kingsberg and Woodard’s1 well-referenced summary of the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)2 definition of the sexual dysfunction of lack of sexual desire, their discussion of evaluation and treatment, and their emphasis on including sexual histories and screens in our visits. They point out that the key phrase in the new definition is low desire resulting in “personal distress.” It is very difficult to separate this personal distress from the distress that results from disparity of desire in relationships and from our hypersexualized society’s expectations of sexuality as an essential part of our lives and relationships. The authors alluded to the “affect (sic) of social factors on sexual desire,” but I would have appreciated more attention paid to the large number of women who experience low desire and seek help for a condition that may simply
Linda Harris, MD Medford, Oregon
REFERENCES 1. Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol 2015;125:477–86. 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5. Washington, DC: American Psychiatric Association; 2013. 3. West SL, D’Alosio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med 2008;168: 1441–9.
In Reply: We support Dr. Harris’s efforts to counsel her patients who present with concerns about sexual desire. We agree that women may experience periods of time when desire waxes and wanes; this is not hypoactive sexual desire disorder. We believe that her concern that
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
In Reply: The authors thank Lindau et al for bringing attention to the role that cancer and its prevention or treatment plays in women’ s sexuality and sexual wellbeing. Cancer-related sexual dysfunction is an important quality-of-life issue; sexual health is one of eight areas covered by the National Comprehensive Cancer Network Guidelines for survivorship, which recommend that providers screen patients for sexual problems at regular intervals from the time of cancer diagnosis through the balance of their lives.1 Indeed, cancer can affect all domains of sexual functioning in complex ways.2 This highlights the importance of asking all women about sexual concerns and being open-minded about the effects that coexisting medical conditions, including cancer, can have on sexual function. In addition to the biological and psychological factors that influence libido, women with cancer may also experience changes in relationship dynamics with an intimate partner (who is also often a caregiver) that might negatively affect desire.3 Our review4 is intended to provide a general overview of the diagnosis and treatment of low desire in women, and we agree that the potential consequences of cancer and its prevention and treatment should be considered when evaluating a woman with this complaint. Given the myriad ways that sexual function and well-being can be affected in women with any cancer type, we believe that this topic warrants a separate and more thorough review. Financial Disclosure: Dr. Kingsberg is a consultant or sits on advisory boards for Sprout, Palatin, Pfizer, Shionogi, Trimel, Apricus, Strategic Solutions Technology, Nuelle, NovoNordisk, Metagenics, Emotional Brain, Endoceutics, Sermonix, and Teva. The other author did not report any potential conflicts of interest.
1496
Letters
Sheryl A. Kingsberg, PhD University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio Terri Woodard, MD The University of Texas MD Anderson Cancer Center and Baylor College of Medicine, Houston, Texas
REFERENCES 1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: survivorship (version 1.2015). Available at: http:// www.nccn.org/professionals/physician_gls/ pdf/survivorship.pdf. Retrieved February 27, 2015. 2. DeSimone M, Spriggs E, Gass JS, Carson SA, Krychman ML, Dizon DS. Sexual dysfunction in female cancer survivors. Am J Clin Oncol 2014;37: 101–6. 3. Rolland J. In sickness and in health: the impact of illness on couples’ relationships. J Marital Fam Ther 1994;20: 327–47. 4. Kingsberg SA, Woodard T. Female sexual dysfunction. Focus on low desire. Obstet Gynecol 2015;125:477–86.
be their normal state. I believe that our failure to recognize that lack of desire can be a normal variant in the spectrum of sexual response leads to much of the personal distress creating the diagnosis of sexual dysfunction. Homosexuality was once considered a disorder by the DSM, with societal disapproval creating much “personal distress” in those “suffering from” this disorder. The Asexual Visibility and Education Network seeks to educate the public that there are individuals who do not experience sexual attraction and those who have little interest in sex (most for their entire lives) and that these individuals can still lead happy, productive lives and experience fulfilling relationships. Additionally, the fact that a phone survey by West et al3 revealed an incidence of low sexual desire of more than 50% in naturally postmenopausal women in 2008 emphasizes that decrease in sexual desire is a normal part of aging for women. It can be therapeutic to counsel that lack of desire is not necessarily pathologic. Financial Disclosure: The author did not report any potential conflicts of interest.
Female Sexual Dysfunction: Focus on Low Desire To the Editor: I appreciated Drs. Kingsberg and Woodard’s1 well-referenced summary of the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)2 definition of the sexual dysfunction of lack of sexual desire, their discussion of evaluation and treatment, and their emphasis on including sexual histories and screens in our visits. They point out that the key phrase in the new definition is low desire resulting in “personal distress.” It is very difficult to separate this personal distress from the distress that results from disparity of desire in relationships and from our hypersexualized society’s expectations of sexuality as an essential part of our lives and relationships. The authors alluded to the “affect (sic) of social factors on sexual desire,” but I would have appreciated more attention paid to the large number of women who experience low desire and seek help for a condition that may simply
Linda Harris, MD Medford, Oregon
REFERENCES 1. Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol 2015;125:477–86. 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition: DSM-5. Washington, DC: American Psychiatric Association; 2013. 3. West SL, D’Alosio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med 2008;168: 1441–9.
In Reply: We support Dr. Harris’s efforts to counsel her patients who present with concerns about sexual desire. We agree that women may experience periods of time when desire waxes and wanes; this is not hypoactive sexual desire disorder. We believe that her concern that
OBSTETRICS & GYNECOLOGY
Copyright ª by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
