Cover
Title Page
List of Contributors
Foreword
Preface
1 History of the International Society for the Study of Women’s Sexual Health (ISSWSH)
1. References
2 Sexual Medicine Education and Training
1. Introduction
2. Education and Training in Female Sexual Health Care for Practicing Clinicians
3. Education and Training in Female Sexual Health Care for Sexual Medicine Specialists
4. Conclusion
5. References
Part I: Hypoactive Sexual Desire Disorder
1. 3 Nosology and Epidemiology of Hypoactive Sexual Desire Disorder
  1. Nosology
  2. Epidemiology
  3. References
2. 4 Central Nervous System Anatomy and Neurochemistry of Sexual Desire
  1. Introduction
  2. The Sexual Brain
  3. Structure of Female Sexual Behavior
  4. Sexual Behavior of Human Females
  5. Ovarian Hormones Set the Stage
  6. How do We Study the Central Nervous System Regulation of Female Sexual Desire?
  7. Excitation, Inhibition, and Disinhibition of Sexual Responses
  8. Sexual Approach Behaviors
  9. Solicitations
  10. Pacing Behavior
  11. Lordosis
  12. Relevance of Animals to Humans
  13. References
3. 5 Psychological Management of Hypoactive Sexual Desire Disorder
  1. Introduction
  2. Psychotherapy/Sex Therapy for Hypoactive Sexual Desire Disorder
  3. Psychotherapy/Sex Therapy Outcomes
  4. Integrating Psychotherapy in Multimodal Treatments for Hypoactive Sexual Desire Disorder
  5. Conclusion
  6. References
4. 6 Pathophysiology and Medical Management of Hypoactive Sexual Desire Disorder
  1. Neurobiological Endocrinology
  2. Pathophysiology
  3. Diagnosis
  4. Therapeutic Strategies for Hypoactive Sexual Desire Disorder
  5. Conclusions
  6. References
Part II: Arousal Disorders
1. 7 Nosology and Epidemiology of Arousal Disorders in Women
  1. Nosology
  2. Epidemiology
  3. References
2. 8 Anatomy and Physiology of Arousal
  1. Introduction
  2. Hemodynamic Considerations for Genital Sexual Arousal
  3. Neural Regulation of Sexual Arousal
  4. Regulation of Vaginal Lubrication
  5. Modulation of Female Genital Arousal by Sex Steroid Hormones
  6. Summary and Conclusions
  7. References
3. 9 Psychological Management of Arousal Disorders
  1. Introduction
  2. Etiology: Psychological Factors that Impact Sexual Arousal
  3. The Effects of Partner Dysfunction in Women
  4. Health and Lifespan Considerations
  5. Assessment of Sexual Response
  6. Nonpharmacological Treatments
  7. Psychological Treatment
  8. Conclusions
  9. References
4. 10 Pathophysiology and Medical Management of Female Genital Arousal Disorder
  1. Physiology of Female Genital Arousal Responses
  2. Subjective Component of Female Sexual Arousal
  3. Nomenclature – Female Sexual Arousal Disorder (FSAD)
  4. Risk Factors for Women with FGAD
  5. Endocrine Changes and Endocrine Risk Factors in Women with Female Genital Arousal Disorder
  6. Diagnosis of Women With Female Genital Arousal Disorder
  7. Treatment of Women with Female Genital Arousal Disorder
  8. Neurologic Interventions
  9. Conclusions
  10. References
5. 11 Pathophysiology and Medical Management of Persistent Genital Arousal Disorder
  1. Introduction
  2. International Society for the Study of Women’s Sexual Health (ISSWSH) Consensus Conference Nomenclature – Persistent Genital Arousal Disorder
  3. Risk Factors and Clinical Etiology of Persistent Genital Arousal Disorder
  4. Diagnosis of Women with Persistent Genital Arousal Disorder
  5. Treatment of Women with Persistent Genital Arousal Disorder
  6. Conclusion
  7. References
Part III: Orgasm Disorders
1. 12 Nosology and Epidemiology of Female Orgasm Disorder
  1. Nosology
  2. Epidemiology
  3. References
2. 13 Peripheral and Central Neural Bases of Orgasm
  1. Functional Anatomy
  2. Brain Activity and Correlates of Orgasm
  3. References
3. 14 Psychological Management of Orgasm Disorders
  1. Introduction
  2. Orgasm
  3. Orgasms and the Sexual Response Cycle
  4. Orgasms within the Cultural Framework
  5. Orgasm Dysfunctions
  6. Assessment
  7. Diagnosis
  8. Management/Treatment
  9. Follow‐Up and Referral
  10. Acknowledgements
  11. References
4. 15 Musculoskeletal Management of Orgasm Disorders
  1. Introduction
  2. Diagnosis
  3. Evaluation of Musculoskeletal Function
  4. Categories of Myofascial and Musculoskeletal Dysfunction
  5. Overview of Treatment Options
  6. Outcomes/Follow‐Up
  7. Screening/prevention
  8. Conclusion
  9. References
5. 16 Pathophysiology and Medical Management of Female Orgasm Disorder
  1. Introduction
  2. Genital Responses Prior to, During and Immediately after Orgasm in Women
  3. ISSWSH Consensus Conference Nomenclature – Female Orgasm Disorder
  4. Female Orgasm Disorders (ISSWSH Consensus Conference Nomenclature)
  5. Risk Factors for Women with Female Orgasm Disorder
  6. Diagnosis of Women with Female Orgasm Disorder
  7. Treatment of Women with Female Orgasm Disorder
  8. Conclusions
  9. References
6. 17 Pathophysiology and Medical Management of Female Orgasmic Illness Syndrome
  1. Introduction
  2. ISSWSH Consensus Nomenclature – Female Orgasmic Illness Syndrome
  3. Central Aversive Symptoms
  4. Peripheral Aversive Symptoms
  5. Conclusions
  6. References
Part IV: Sexual Pain Disorders
1. 18 Nosology and Epidemiology of Dyspareunia and Vulvodynia
  1. Background
  2. Nosology
  3. Genetic Factors
  4. Hormonal Factors
  5. Inflammation
  6. Musculoskeletal
  7. Neurologic Mechanisms – Central
  8. Peripheral – Neuro‐Proliferation
  9. Psychosocial Factors
  10. Embryological/Congenital Factors
  11. Associated Factors – Conclusion
  12. Additional Nosology
  13. Prevalence
  14. Impact
  15. Conclusion
  16. References
2. 19 Anatomy and Physiology of Sexual Pain
  1. Introduction
  2. Nociceptor Structure and Function
  3. Hormonal Regulation
  4. Somatic and Visceral Pain
  5. Referred Pain
  6. Vascular Pain
  7. Inflammation
  8. Peripheral and Central Sensitization
  9. The Brain
  10. Novel Future Directions
  11. Summary
  12. References
3. 20 Psychological Management of Provoked Vestibulodynia
  1. Provoked Vestibulodynia
  2. Psychosocial Factors
  3. Treatment
  4. Conclusions
  5. References
4. 21 Musculoskeletal Management of Pelvic and Sexual Pain Disorders
  1. Introduction
  2. Pelvic Floor Anatomy
  3. Pathophysiology of Sexual Pain
  4. Musculoskeletal Evaluation
  5. Physical Therapy Treatment of Pelvic and Sexual Pain Disorders
  6. Physical Therapy Treatment Techniques
  7. Adjunctive Modalities
  8. Treatments with Physician Collaboration
  9. Treatment for Specific Sexual Pain Diagnoses
  10. Hormonally‐Induced Dyspareunia
  11. Conclusion
  12. References
5. 22 Medical Management of Dyspareunia and Vulvovaginal Pain
  1. Introduction
  2. Evaluation
  3. Treatment
  4. Conclusions
  5. References
Part V: Future
1. 23 Future Developments and Research
  1. Introduction: Historical and Regulatory Perspective
  2. The Marketplace
  3. References
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Dates and locations of ISSWSH annual meetings and the presidents at that time.
Chapter 02
1. Table 2.1 Competencies for undergraduate, graduate and generalist physicians, and postgraduate specialists.
2. Table 2.2 Modified nine‐field diagram [10] for the comprehensive explanatory diagnosis.
3. Table 2.3 Disease and therapy specific factors having an impact on female sexual function [3].
4. Table 2.4 Management of the patient with desire disorder [9, 19, 20].
5. Table 2.5 Management of the patient with arousal disorder [9, 21].
6. Table 2.6 Management of the patient with orgasmic disorder.
Chapter 06
1. Table 6.1 Blood production rate and relative contribution (%) of glandular secretions and peripheral conversion to blood production of sex steroids in young adult women.
2. Table 6.2 Blood levels of the main sex steroids at different periods of reproductive life.
Chapter 09
1. Table 9.1 Sexual history.
2. Table 9.2 Common female sexual health assessment instruments and arousal‐related items.
Chapter 13
1. Table 13.1 Histological findings in clitoris and vagina [8].
2. Table 13.2 Innervation of female sexual organs.
3. Table 13.3 Vascularization of female sexual organs.
Chapter 19
1. Table 19.1 Structure and function of peripheral sensory afferent neurons mediating genito‐pelvic sensation and pain.
2. Table 19.2 Symptom patterns and mechanisms underlying different types of pain.
3. Table 19.3 Therapeutic mechanisms of action targeting nociception in genito‐pelvic pain.
Chapter 20
1. Table 20.1 General and specific domains for a comprehensive pain and psychosocial assessment.
Chapter 22
1. Table 22.1 Useful questions when obtaining a sexual pain history.

List of Illustrations

Chapter 01
1. Figure 1.1 Sandra Leiblum, PhD, first president of the International Society for the Study of Women’s Sexual Health, presiding over the business meeting.
Chapter 02
1. Figure 2.1 Algorithm incorporating the specific medical condition.
Chapter 04
1. Figure 4.1 Sexual tipping point model of sexual excitation and inhibition. Cultural, psychological, and physiological factors conspire to tip the balance either toward excitation or inhibition. Sexually functional individuals maintain a degree of lability in the balance, and an ability to have it tipped toward either excitation or inhibition. Persons with hypoactive sexual desire disorder are likely to have the balance weighed down by inhibition. This can occur because of hypofunctional excitation, hyperfunction inhibition, or a combination of the two. After Perelman [67].
2. Figure 4.2 A wiring diagram of sexual excitation and inhibition in the mammalian brain that reflects current understanding of neuroanatomical and neurochemical pathways. VTA: Ventral tegmental area; SN: substantia nigra.
3. Figure 4.3 The “EPOR” (Excitation, Plateau, Orgasm, Resolution) model of Masters and Johnson, with modifications by Kaplan [21] and Georgiadis et al. [24] to fit more current models of arousal, desire, and incentive motivation.
4. Figure 4.4 Circular feedback model of sexual responsiveness by Basson. Note that experience with sexual reward in the model can increase the likelihood of response, whereas experience with sexual nonreward or punishment can diminish expectations of pleasure that reduce the functionality of the feedback system.
5. Figure 4.5 Top: Ovulatory cycles of humans (left) and rats (right). Bottom: Sexual desire in humans and rhesus macaques. Note how measures of desire peak around the time of ovulation. Secondary peaks have been reported around the time of menstruation in humans.
6. Figure 4.6 Patterns of brain activation in response to sexual stimulation as a function of the EPOR stages of sexual response.
7. Figure 4.7 Neurochemical mechanisms of sexual excitation and inhibition.
8. Figure 4.8 Neurochemical mechanisms of sexual excitation within a tipping point model. Left: sexual excitation. Right: Sexual inhibition.
9. Figure 4.9 Treatments for sexual desire disorders and their potential mechanisms of action in the brain.
Chapter 05
1. Figure 5.1 Biopsychosocial model of sexual response.
Chapter 06
1. Figure 6.1 Biosynthesis of steroid hormones. The enzymes involved in androgen and estrogen biosynthesis or metabolism are indicated by numbers. 1 = 20,22‐desmolase; 2 = 3β‐hydroxysteroid dehydrogenase‐isomerase; 3 = 17α‐hydroxylase; 4 = 17,20‐desmolase; 5 = 17β‐hydroxysteroid dehydrogenase; 6 = 5α‐reductase; 7 = 3β‐ketoreductase; 8 = aromatase; 9 = 16α‐hydroxylase.
2. Figure 6.2 Hormonal fluctuations during menstrual cycle. Body temperature change is also shown.
Chapter 08
1. Figure 8.1 Physiology of sexual desire/interest and central arousal.
2. Figure 8.2 Interaction between cellular constituents of the vagina and the physiological processes mediated by them.
3. Figure 8.3 Mechanisms of transvaginal epithelial permeability.
4. Figure 8.4 Proposed mechanisms of sex steroid hormone action in regulating vaginal function. Binding of steroid hormones to specific receptors (intracellular or membrane bound) leads to genomic and nongenomic activation of cellular processes. These include regulation of steroid receptor synthesis, activation of ion channels, increased DNA synthesis, regulation of growth factors, and neurotransmitter synthesis. The cascade of events triggered by sex steroid hormone binding brings about changes in vaginal tissue structure and function that modulate the vaginal arousal response to sexual stimulation.
Chapter 11
1. Figure 11.1 Schematic representation of a herniated intervertebral disc at L5‐S1 impinging on, and irritating, the nerve roots of the cauda equina. If the radiculitis affects the sacral spinal nerve roots (SSNR) various neurogenic sexual dysfunctions, such as persistent genital arousal disorder (PGAD), may be experienced. Several cures of men and women with PGAD secondary to radiculitis of the SSNR have been realized with minimally‐invasive out‐patient lumbar spine surgery.
Chapter 13
1. Figure 13.1 Anatomy of the CUV complex. Schematic representation of the external and internal clitoris and the vaginal opening. The insert, an anterior vaginal wall obtained from a cadaver [15, 21], represent the intimate relationships between all the different anatomical structures involved in the female sexual pleasure.
2. Figure 13.2 Descriptive “tapestry” representation of brain activity in response to clitoral self‐stimulation leading up to, during, and after orgasm in each of six women. Each woman’s tapestry consists of 80 columns, each column representing a Brodmann area. Each row represents a successive two‐second sample of functional MRI activity, starting at the top. The relative magnitude of brain activity in each region at each time period is represented as brightness. The shorter vertical bars to the right of each tapestry represents the onset and duration of orgasm; the longer bars represent the onset and duration of clitoral self‐stimulation. Note the maximum activation in widespread brain regions during orgasm, in contrast to the variable patterns of regional brain activity leading up to, and after, orgasm. These descriptive data and those in the subsequent figures comprise part of the doctoral dissertation of Dr Nan Wise at Rutgers University. Dr Eleni Frangos collaborated in portions of the research.
3. Figure 13.3 Preliminary group fMRI data (N = 10) providing evidence that maximum overall activation in widespread regions of the brain was observed at orgasm. Multiple brain “sections” are shown, representing the regions identified by the labels above them. The data were generated by subtracting one 10‐second epoch from another. Thus, activity during the first 10 s of stimulation (“Early stim”) was subtracted from the 10‐s activity midway between the start of stimulation and the start of orgasm (“Mid stim”). The activity at mid‐stim was subtracted from the 10‐s epoch starting when the women pressed a button indicating initiation of orgasm. The subsequent postorgasm responses were comparably subtracted as indicated (“recovery” refers to the phase after the women pressed the button to indicate the end of their orgasm). Abbreviations: amyg: amygdala; ant cing: anterior cingulate cortex; hpc: hippocampus; nacc: nucleus accumbens; pc: parietal cortex; pcl: paracentral lobule; pfc: prefrontal cortex; post cing: posterior cingulate cortex; post insl: posterior insula; SII: Supplementary sensory cortex (operculum); vta: ventral tegmental area.
4. Figure 13.4 Preliminary group data providing evidence of regional activation pattern “going over” into orgasm. The group activity in each region during the 10 seconds immediately prior to the button press was subtracted from the 10 seconds immediately after the button press, by which the women indicated the start of their orgasm. Brain areas activated at criterion of z = 1.65 are labeled by a square; those at a criterion of z = 1.55 are labeled by a circle. Brain areas from the brain stem analysis are labeled by an asterisk and are activated at a criterion of z = 1.0. While the latter two z criteria are lower than customary, the data are shown in order to represent activity in brainstem regions represented by very few voxels, which might otherwise be subject to a type 2 error.
Chapter 14
1. Figure 14.1 Female sexual response model developed by Masters and Johnson, 1966 [6].
2. Figure 14.2 Circular model of female sexual response developed by Whipple and Brash‐McGreer, 1997 [8].
3. Figure 14.3 Nonlinear model of female sexual response developed by Basson, 2000 [10].
Chapter 15
1. Figure 15.1 Testing pelvic girdle for incoordination – Stork test/Trendelenberg test.
2. Figure 15.2 Testing functional positions of sexual activity – quadriped with pelvic tilting.
3. Figure 15.3 Functional testing for sexual positions – “happy baby” pose.
4. Figure 15.4 Coordination of pelvic girdle for sexual function – bridge with breathing.
5. Figure 15.5 Abdominal strength testing – Sarhmann progression.
Chapter 19
1. Figure 19.1 A circle graph depicts pain referral patterns between 14 anatomically‐distinct body locations that exhibit spinal “cross‐talk.” Depicted body regions are innervated by either somatic nociceptors (left, in blue) or visceral nociceptors (right, in red). The lines connecting body locations represent either (a) viscero–visceral (organ to organ) interactions, indicated in with grey dashed lines, or (b) viscero–somatic (organ to muscle/skin) interactions, indicated with solid red lines. Methods of data collection include electrophysiology, animal behavior with symptom comodulation, and quantitative sensory testing techniques in women. Note that additional pain referral patterns between structures on this circle graph almost certainly exist, but are not supported by current research.
2. Figure 19.2 Hypothetical referred pelvic pain patterns supported by the clinical literature that are suggestive of spinal cross‐talk between visceral and somatic nociceptors. (a) Based on the clinical co‐occurrence of uterine cramps and low back pain, this schematic depicts visceral pain originating in the uterus (far left) as a potential cause of somatic pain referred to muscles in the lower back (viscero–somatic referred pain, middle). Alternatively, uterine pain could also refer to a visceral structure like the bladder (viscero–visceral referred pain, far right) to create more diffuse pelvic pain. (b) Given the co‐occurrence of pelvic floor muscle dysfunction/pain and chronic vulvar pain, this schematic depicts somatic–visceral pain originating at the vulvar vestibule (far left, due to dual innervation of the lower one‐third of the female reproductive tract) as a potential cause of somatic pain referred to pelvic floor muscles (somato–/viscero–somatic referred pain, middle). In contrast, vulvar pain referral to the bladder has been described and is supported by high clinical comorbidity between chronic vulvar and bladder pain (somato–/viscero–visceral referred pain, far right). Both clinical presentations (a) and (b) would likely include both localized and diffuse pelvic pain. Note that referred pain is a normal feature of visceral pain and the interactions shown here are not “pathological” if the referred pain resolves in a timely manner.
3. Figure 19.3 Spatial characteristics of primary and secondary hyperalgesia (enhanced pain sensitivity) that would be expected with injury/inflammation at the (a) vulvar vestibule or (b) uterus. Primary hyperalgesia occurs at the site of injury as a natural consequence of peripheral nociceptor sensitization. These nociceptors may trigger spinal cord central sensitization of dorsal horn interneurons, which generates a region of secondary hyperalgesia that surrounds the region of primary hyperalgesia (injury/inflammatory site) that is only hypersensitive to noxious mechanical stimulation. This phenomenon can account for mechanical hyperalgesia in vulvar tissue surrounding the vulvar vestibule in women with provoked vestibulodynia (a). A parallel (and hypothetical) example is provided for primary hyperalgesia originating with uterine injury/inflammation (b). In this example, secondary hyperalgesia in surrounding uterine tissue may not be perceived as a distinct pain because both sites of visceral hyperalgesia produce similar diffuse sensations of pain. Note that central sensitization is a normal (albeit time‐limited) consequence of strong inflammatory pain and the interactions shown here are not “pathological” if the secondary hyperalgesia resolves in a timely manner and the primary hyperalgesia dissipates soon thereafter.
Chapter 21
1. Figure 21.1 Female urogenital system – mid‐sagittal section.
2. Figure 21.2 Female pelvic floor anatomy.
3. Figure 21.3 Coccygeus, piriformis, and obturator internus muscles.
4. Figure 21.4 Cutaneous nerves of the vulva, thigh, and groin.
Chapter 22
1. Figure 22.1 Examination of the vulva with a colposcope.
2. Figure 22.2 Vulvar lichen sclerosus. Changes seen include complete resorption of the labia minora, complete phimosis of the glans clitoris, and narrowing of the introitus.
3. Figure 22.3 Cotton swab test of the vulvar vestibule.
4. Figure 22.4 Erythema of the ostia of the Bartholin gland in a patient with hormonally associated vestibulodynia.
5. Figure 22.5 Vulvar pain diagnostic and treatment algorithm.

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Library of Congress Cataloging‐in‐Publication Data

Names: Goldstein, Irwin, editor. | Clayton, Anita H., editor. | Goldstein, Andrew, M.D., editor. | Kim, Noel N., editor. | Kingsberg, Sheryl A., editor.
Title: Textbook of female sexual function and dysfunction : diagnosis and treatment/edited by Irwin Goldstein, Anita H. Clayton, Andrew T. Goldstein, Noel N. Kim, Sheryl A. Kingsberg.
Description: Hoboken, NJ : Wiley, 2018. | Includes bibliographical references and index. |
Identifiers: LCCN 2017055314 (print) | LCCN 2017056729 (ebook) | ISBN 9781119266112 (pdf) | ISBN 9781119266150 (epub) | ISBN 9781119266136 (oBook) | ISBN 9781119266099 (cloth)
Subjects: | MESH: Sexual Dysfunction, Physiological–diagnosis | Sexual Dysfunction, Physiological–therapy | Women | Sexuality–physiology
Classification: LCC RC556 (ebook) | LCC RC556 (print) | NLM WP 610 | DDC 616.85/83–dc23
LC record available at https://lccn.loc.gov/2017055314

Cover Design: Wiley
Cover Image: © Vectorig/Getty Images

List of Contributors

Stanley E. Althof, PhD, IF
Center for Marital and Sexual Health of South Florida
West Palm Beach, FL, USA

Sophie Bergeron, PhD
Département de Psychologie
Université de Montréal
Montréal, QC, Canada

Johannes Bitzer, MD, IF
University Hospital Basel
Multidisciplinary Center for Sexual Medicine
Basel, Switzerland

Karen Brandon, DSc PT WCS, BCB‐PMD
Kaiser Permanente
Fontana, CA, USA

Anita H. Clayton, MD, IF, FAPA, FASCP
Department of Psychiatry and Neurobehavioral Sciences
University of Virginia School of Medicine
Charlottesville, VA, USA

Leonard R. Derogatis, PhD
Maryland Center for Sexual Health
Towson, MD, USA

Melissa A. Farmer, PhD
Department of Physiology
Feinberg School of Medicine
Northwestern University
Chicago, IL, USA

Eleni Frangos, PhD
Pain and Integrative Neuroscience Branch
NCCIH–NIH
Bethesda, MD, USA

Andrew T. Goldstein, MD, FACOG, IF
Department of Obstetrics and Gynecology
The George Washington University School of Medicine and Health Sciences
Centers for Vulvovaginal Disorders
Washington, DC, USA

Irwin Goldstein, MD, IF
Sexual Medicine
Alvarado Hospital
Department of Surgery
University of California, San Diego
San Diego Sexual Medicine
San Diego, CA, USA

Sue W. Goldstein, CSE, CCRC, IF
San Diego Sexual Medicine
San Diego, CA, USA
Emmanuele A. Jannini, MD
Department of Systems Medicine
University of Rome Tor Vergata
Rome, Italy

Sherri L. Jones, PhD
Douglas Mental Health University Institute
Department of Psychiatry, McGill University
Montreal, QC, Canada

Susan Kellogg Spadt, PhD, CRNP, IF, FCST, CSC
Center for Pelvic Medicine
Bryn Mawr, PA, USA

Noel N. Kim, PhD, IF
Institute for Sexual Medicine
San Diego, CA, USA

Sheryl A. Kingsberg, PhD, IF
Division of Behavioral Medicine
Department of OB/GYN
University Hospitals Cleveland Medical Center
Departments of Reproductive Biology and Psychiatry
Case Western Reserve University School of Medicine
Cleveland, OH, USA

Barry R. Komisaruk, PhD
Department of Psychology
Rutgers University
Newark, NJ, USA

Tuuli M. Kukkonen, PhD, CPsych
Department of Family Relations and Applied Nutrition
University of Guelph
Guelph, ON, Canada

Fiona McMahon, PT, DPT
Beyond Basics Physical Therapy, LLC
New York, NY, USA

Sara Nasserzadeh, PhD, DipPST
Relationship & Sexual Health Consultants
Palo Alto, CA, USA

Sharon J. Parish, MD, IF
Department of Medicine in Clinical Psychiatry
Department of Clinical Medicine
Weill Cornell Medical College
New York, NY, USA

Kwangsung Park, MD, PhD, IF
Department of Urology
Chonnam National University Medical School
Gwangju, Republic of Korea

James G. Pfaus, PhD, IF
Center for Studies in Behavioral Neurobiology
Department of Psychology, Concordia University
Montréal, QC, Canada

Caroline F. Pukall, PhD, CPsych
Department of Psychology
Queen’s University
Kingston, ON, Canada

Tami Serene Rowen, MD, MS, IF
Department of Obstetrics, Gynecology and Reproductive Sciences
University of California, San Francisco
San Francisco, CA, USA

Sara K. Sauder, PT, DPT
Austin, TX, USA

Isbelia Segnini, MSc, CCRC, C‐AASECT
Clinical El Cedral
Caracas, Venezuela

James A. Simon, MD, CCD, NCMP, IF, FACOG
IntimMedicine Specialists™
George Washington University School of Medicine
Washington, DC, USA

Amy Stein, DPT, BCB‐PMD, IF
Beyond Basics Physical Therapy, LLC
New York, NY, USA

Linda Vignozzi, MD
Sexual Medicine and Andrology Unit
Department of Experimental and Clinical Biomedical Sciences
University of Florence
Florence, Italy

Nan Wise, PhD
Department of Psychology
Rutgers University
Newark, NJ, USA

Preface

The International Society for the Study of Women’s Sexual Health (ISSWSH) is an international, multidisciplinary, academic, clinical and scientific organization dedicated to providing opportunities for communication among scholars, researchers and practitioners about women’s sexual health; to support the highest standards of ethics and professionalism in research, education and clinical practice of women’s sexual health; and to provide the public with accurate information about women’s sexual health.

ISSWSH strongly emphasizes and fervently supports the biopsychosocial management of women with sexual dysfunction. With that encompassing mission and scientific focus in mind, the ISSWSH Textbook of Female Sexual Function and Dysfunction: Diagnosis and Treatment has been written by ISSWSH members primarily to help healthcare providers in the various disciplines involved in women’s sexual health, including sex therapy, pelvic floor physical therapy and medical therapy, better manage women with distressing sexual health issues. Since ISSWSH is the largest society comprised of specialists in women’s sexual health, the idea for an ISSWSH textbook to provide the optimal scientific, multidisciplinary clinical practice guidelines for use by providers was natural. With millions of women needing help, ISSWSH members can provide accurate data for the providers in the various disciplines caring for women with sexual health concerns. By writing a textbook on female sexual dysfunction based on published laboratory and clinical research and expert clinical experience, ISSWSH is able to further its mission of communication, professionalism and disseminating information.

The multidisciplinary field of women’s sexual health has come a long way since the inaugural meeting of ISSWSH in 2000. For almost two decades, ISSWSH has fostered research in the study, nosology, diagnosis and treatment of women with sexual health disorders. ISSWSH funds research projects in women’s sexual health, especially important in an era where government funds are lacking. ISSWSH supports numerous educational opportunities including annual meetings, educational courses, and publications from consensus‐based panels resulting in nomenclature, white paper and process of care documents. ISSWSH, an affiliate member society of the International Society for Sexual Medicine (ISSM), has three official journals: The Journal of Sexual Medicine, Sexual Medicine, and Sexual Medicine Reviews. Using these and other journals that publish in women’s sexual health, ISSWSH has helped grow scientific peer‐reviewed publications in women’s sexual health, expanding from 273 scientific peer‐reviewed publications found in PubMed in 2000 (by using the key phrase “female sexual dysfunction”) to 772 in 2016 – almost tripling available literature, much of which has been authored by ISSWSH members.

This ISSWSH textbook is intended to provide clinical practice guidelines for both novice and expert practitioners treating women with sexual health concerns. In the ten years since the publication of the first multidisciplinary textbook in the field, Women’s Sexual Function and Dsyfunction, our knowledge has expanded and medications for treating various sexual dysfunctions have been added in some countries to the nonpharmacologic treatment strategies already available. As an official publication of the society, this material has been vetted by the editors on behalf of ISSWSH. Four of the editors (Clayton, I. Goldstein, A. Goldstein, Kingsberg) have been presidents of the society while the fifth (Kim) is president‐elect. We have all given of our time freely because of our passion for the field and our passion for ISSWSH, as has the associate editor, Sue W. Goldstein. In particular, Sue spent countless hours as the central communicator, tracker of progress, and editorial associate, guiding this book from initial development to final publication. We would also like to thank Gail Goldstein for her time and efforts in helping to edit the pain section.

It is imperative that clinicians understand the various conditions impacting sexual desire, arousal, orgasm, and pain, how to make a correct diagnosis, the therapeutic options available, and the science behind the various treatments, in order to provide optimal patient management and improve patient quality of life. All women have the right to health, including sexual health. The Textbook of Female Sexual Function and Dysfunction: Diagnosis and Treatment will serve as a valuable tool to all those involved in helping women maintain or restore their sexual health.

For ease of use, the text is divided into four basic sections: Hypoactive Sexual Desire Disorder, Arousal Disorders, Orgasm Disorders, and Sexual Pain Disorders. Within each section there is content on the nosology and epidemiology, anatomy and physiology, and diagnosis and treatment from both psychologic and biologic points of view, including musculoskeletal management where appropriate.

It is anticipated that ISSWSH will update this textbook as needed. The field of women’s sexual medicine is rapidly evolving and ISSWSH members have been influential in paving the way for expansion of knowledge in the field of female sexual dysfunction – this textbook reflects current understanding. We hope that you agree and find the Textbook of Female Sexual Function and Dysfunction to be an essential resource in caring for women and their sexual health.

Irwin Goldstein, MD, IF
Anita H. Clayton, MD, IF
Andrew T. Goldstein, MD, IF
Noel N. Kim, PhD, IF
Sheryl A. Kingsberg, PhD, IF