Epidemiology

Sexual dysfunction is a disease affecting men and women of all ages.1 The Massachusetts Male Aging Study,2 one of the largest epidemiologic studies, revealed the high prevalence of ED. In fact, it was shown that 52% of men between the ages of 40 and 70 had ED. Subsequent epidemiologic studies in women suggested that FSD was also an extremely prevalent problem. A report in the Journal of the American Medical Association3 suggested that 43% of women, aged 18 to 59, had FSD. In fact, the prevalence of FSD in this study was greater than that of ED.3 Of note, FSD is more prevalent in patients with a history of sexual abuse and is often reported in women with a history of sexual coercion. In a study reported at the Annual Meeting of the American Urologic Association in 2000, Nehra and associates looked at the prevalence of FSD in the partners of men with ED. One hundred fifty women were evaluated, aged 25 to 82 years. The study revealed that 56% of these women had FSD, and demonstrated specific vascular risk factors, including cigarette smoking, hypercholesterolemia, hypertension, and prior pelvic surgery. Based on population surveys, this would suggest that more than 30 million women in the United States might have FSD. Unfortunately, despite this high prevalence, it has been estimated that less than 5% of women with FSD are being treated.

Several explanations for the phenomenon of FSD have been proposed. These include embarrassment on the part of the patient to discuss personal sexual matters or a feeling that her concerns would be "brushed aside," embarrassment or lack of time on the part of the physician (man or woman), and lack of education regarding the prevalence, significance, and treatment options available for FSD.

The question arises as to why the identification and treatment of FSD is important. Despite the belief of many physicians that the treatment of sexual dysfunction is not a "medical" priority, it is crucial to remember that normal sexual function is an important part of the essential intimacy between a woman and man ("the COUPLE"). Furthermore, sexual dysfunction often leads to loss of self-esteem, depression, and alienation from one's partner. In addition, similar to its counterpart in the male (ED), FSD is a spectrum of disease and may be an early warning sign of significant unrecognized systemic vascular disease indicating an increased risk for heart attack or stroke.

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