Attitudes toward Management of Decreased Sexual Desire in Premenopausal Women: A National Survey of Nurse Practitioners and Physician Assistants

By Mansell, Dorcas; Salinas, Gregory D. et al. | Journal of Allied Health, Summer 2011 | Go to article overview

Attitudes toward Management of Decreased Sexual Desire in Premenopausal Women: A National Survey of Nurse Practitioners and Physician Assistants


Mansell, Dorcas, Salinas, Gregory D., Sanchez, Andrew, Abdolrasulnia, Maziar, Journal of Allied Health


Recent studies have determined that low sexual desire affects between one quarter to one third of adult premenopausal women, leading to distress. The prevalence of distress from low desire may suggest management gaps in the clinicians managing these patients, as recent studies have shown a reluctance to discuss sexual concerns. A survey based on the Theory of Planned Behavior, a predictive model linking attitudes and behavior, was designed to determine what factors influenced behavioral intent and behavior of nurse practitioners and physician assistants when managing decreased sexual desire and sexual concerns in premenopausal women. A path analysis found that attitudes and subjective norms were associated with behavioral intent in both groups and explained roughly one third of the intent to initiate a discussion about sexual health. In general, nurse practitioners and physician assistants had positive attitudes toward managing sexual concerns in female patients but were still at times reluctant to initiate sexual health discussions. This study shows that increased education is needed on female sexual dysfunction in the allied health professional community, as well as techniques for communicating with patients about their sexual concerns. J Allied Health 2011; 40(2):64-71.

LOW SEXUAL DESIRE in women is common and may be due to factors such as communication problems with the partner, substance abuse, anxiety or depression, certain medications, prior sexual abuse, or a gynecologic problem, or it may even be a primary medical condition called hypoactive sexual desire disorder (HSDD).1,2 A recent survey of U.S. women found that 26.7% of premenopausal women over age 30 had low sexual desire, while 7.7% of women in that age group had distress about low desire.3 Another study showed similar prevalence findings and correlations between sexual distress and dissatisfaction with sex life in adult women with low sexual desire.4 This prevalence of sexual concern may reveal a management gap for U.S. clinicians, as recent evidence has shown that physicians were unlikely to discuss low sexual desire and lacked knowledge about appropriate management.5 Another survey of physicians again found that few were likely to discuss HSDD with their female patients, as most lacked confidence when conducting these discussions.6

Because of these reported deficits in knowledge and practice in the physician community, we designed a survey to analyze whether these gaps also occurred in nurse practitioner (NP) and physician assistant (PA) practices. NPs and PAs typically care for women who may be at risk for low sexual desire, but to date no studies have been published on their attitudes and practices when treating women with low sexual desire. This study was based on the Theory of Planned Behavior (TPB), and it was designed to assess NP and PA attitudes toward initiating discussions about sexual concerns with premenopausal women and to predict what factors are more critical when deciding whether to initiate a discussion with a patient about sexual health.

The TPB proposes that any specific behavior is more likely to occur when intention to perform the behavior (motivation) is high.7-10 In turn, attitudes toward the behavior, subjective norms, and perceived behavioral control influence motivation (behavioral intent). The TPB has been validated for behavioral motivations and intentions associated with exercise and smoking.11-13 Figure 1 shows the constructs of the TPB and their relationship to actual behavior.

In addition to items composing the Theory of Planned Behavior, the study also included questions on knowledge of HSDD, values about discussing sexual concerns, importance of and confidence in managing low sexual desire, and prior training in treating sexual concerns.

Methods

To conduct this cross-sectional Internet survey, NPs and PAs identified from a database file provided by their respective professional societies were randomly emailed and faxed a link to an online survey hosted by CE Outcomes, LLC. …

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