Table of Contents
- ABOUT DATAMONITOR HEALTHCARE
- About the Women' s Health pharmaceutical analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the FSD market
- There is a low level of satisfaction with currently available
classification diagnostic guidelines for FSD
- Presentation by women with sexual functioning problems is limited by a
number of factors including ' embarrassment' , lack of physician awareness
and education and a need for a referral process/direct access to
specialists
- There is both space and a significant unmet need for a formally
approved product or products for female sexual dysfunction
- CHAPTER 2 INTRODUCTION AND SCOPE
- Scope and objectives
- Breakdown of the Stakeholder Opinions Survey
- CHAPTER 3 COUNTRY TREATMENT TREES
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION
- Introduction
- Theories of female sexual response
- Masters and Johnson' s linear model
- Kaplan' s revision
- Criticisms of early models
- Circular model: Whipple and Brash-McGreer after Reed
- Basson' s non-linear model
- Disease definition and classification
- Classifications and diagnostic criteria of FSD
- ICD-10
- DSM-IV
- AFUD
- Limitations of classifications
- Epidemiology of FSD from secondary published research
- Inherent difficulties in assessing prevalence of FSD
- Country-specific epidemiological estimates
- US National Health and Social Life Survey: widely quoted but open to
criticism
- FSD increases with age in Japanese women
- FSD highly prevalent in young German women
- FSD extensively studied in UK
- The Global Study of Sexual Attitudes and Behaviors
- Epidemiology of FSD according to Datamonitor' s physician survey
- FSD subtypes
- Niche populations and co-morbid conditions
- Partners with erectile dysfunction
- Depression and antidepressants
- Cardiovascular disease
- Diabetes
- Postpartum
- Unmet need in FSD
- Need for improved tools for assessment and diagnosis
- Need for objective measures for FSD
- Need for an approved therapy for FSD
- Need for investment in supporting services and clear referral pathway
- Need for physician education
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS
- Presentation and diagnosis
- Presentation and referral patterns
- Help-seeking behavior and barriers to presentation
- Let' s talk about sex...or not.
- Sexual dysfunction as a primary versus secondary complaint
- Top 10 symptoms and complaints reported at initial presentation
- Screening practices
- Diagnosis, guidelines and satisfaction with classification systems
- Guidelines for diagnosis
- How useful are FSD diagnostic guidelines in clinical practice?
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS
- Treatment options
- Physicians responsible for the treatment of FSD
- Treatment rates
- Non-drug therapy options
- The importance of counseling
- Counseling and therapy most prevalent in US
- Fewer non-drug options in UK
- Devices and lubricants favored over education in Spain
- FDA-approved devices
- Hypoactive sexual desire disorder
- Therapeutic approach - drug versus non-drug treatment
- Drug treatment - monotherapy versus combinations
- HSDD drug treatment breakdown
- Female sexual arousal disorder
- Therapeutic approach - drug versus non-drug treatment
- Drug treatment - monotherapy versus combinations
- FSAD drug treatment breakdown
- BIBLIOGRAPHY
- APPENDIX A
- Physician research methodology
- Physician sample breakdown
- US
- France
- Germany
- Italy
- Spain
- UK
- Contributing experts
- APPENDIX B
- 1. EPIDEMIOLOGY
- 2. SCREENING AND DIAGNOSIS
- 3. TREATMENT PRACTICES
- 3.1 General treatment approach to female sexual dysfunction
- 3.2. Case study - Hypoactive sexual desire disorder (HSDD) and female
sexual arousal disorder (FSAD)
- 3.3 Testosterone therapy for low libido (hypoactive sexual desire
disorder)
- List of Tables
- Table 1: Prevalence of sexual dysfunction and help-seeking behavior in
the US - NHSLS data (%), 1999
- Table 2: US prevalence of FSD based on NHSLS data, 2005
- Table 3: UK prevalence of FSD by subtype in women aged 18-75 years
- Table 4: GSSAB prevalence of female sexual problems by region (%), 2005
- Table 5: Prevalence of low desire in women aged 40-80 years based on
GSSAB data, 2005
- Table 6: Prevalence of lack of orgasm in women aged 40-80 years based
on GSSAB data, 2005
- Table 7: Prevalence of sexual pain in women aged 40-80 years based on
GSSAB data, 2005
- Table 8: Prevalence of arousal problems in women aged 40-80 years
based on GSSAB data, 2005
- Table 9: Percentage of premenopausal patients experiencing each sexual
dysfunction subtype in the US, UK, Spain and Germany/Italy/France, 2005
- Table 10: Percentage of postmenopausal patients experiencing each
sexual dysfunction subtype in the US, UK, Spain and Germany/Italy/France,
2005
- Table 11: Estimated proportion of patients with sexual functioning
problems with co-morbid conditions and potential risk factors in the US,
UK and Spain (%), 2005
- Table 12: Percentage of pre- and post-menopausal women presenting
directly and being referred to respondents for their sexual functioning
problems by country, 2005
- Table 13: Percentage of pre- and post-menopausal women presenting
directly and being referred to respondents for their sexual functioning
problems by respondent type in the US , UK, Spain and
Germany/Italy/France, 2005
- Table 14: Top 10 factors cited by respondents as preventing women who
are experiencing sexual problems from seeking help in the US , UK, Spain
and Germany/Italy/France, 2005
- Table 15: Percentage of premenopausal and postmenopausal patients
experiencing sexual dysfunction as a primary versus secondary complaint by
country, 2005
- Table 16: Percentage of premenopausal and postmenopausal patients
experiencing sexual dysfunction as a primary versus secondary complaint by
respondent type in the US , UK, Spain and Germany/Italy/France, 2005
- Table 17: Percentage of respondents reporting the most common
complaints with sexual functioning at presentation by country, 2005
- Table 18: Respondent satisfaction with current FSD classification
systems by region, 2005
- Table 19: Physician specialties responsible for the treatment of FSD
in sampled countries in the US, UK, Spain and Germany/Italy/ France, 2005
- Table 20: Percentage of patients with FSD receiving each treatment
approach by country and region, 2005
- Table 21: Breakdown of treatment received by premenopausal patients
with HSDD by region (%), 2005
- Table 22: Breakdown of treatment received by postmenopausal women with
HSDD by region (%), 2005
- Table 23: Percentage of premenopausal and postmenopausal HSDD patients
receiving mono or combination prescription drug therapy by region, 2005
- Table 24: Premenopausal HSDD drug treatment by drug class in the US ,
UK, Spain and Germany/Italy/France (%), 2005
- Table 25: Breakdown of drug prescribing in the premenopausal HSDD
population by country and region (%), 2005
- Table 26: Percentage of postmenopausal HSDD patients receiving each
drug therapy option by country and region, 2005
- Table 27: Breakdown of treatment received by premenopausal patients
with FSAD by country (%), 2005
- Table 28: Breakdown of treatment received by postmenopausal patients
with FSAD by country (%), 2005
- Table 29: Percentage of premenopausal and postmenopausal FSAD patients
receiving mono or combination prescription drug therapy by region, 2005
- Table 30: Percentage of premenopausal FSAD patients receiving each
drug therapy option by country and region, 2005
- Table 31: Percentage of postmenopausal FSAD patients receiving each
drug therapy option by country and region, 2005
- Table 32: US physician sample breakdown, 2005
- Table 33: France physician sample breakdown, 2005
- Table 34: Germany physician sample breakdown, 2005
- Table 35: Italy physician sample breakdown, 2005
- Table 36: Spain physician sample breakdown, 2005
- Table 37: UK physician sample breakdown, 2002
- List of Figures
- Figure 1: Sample breakdown by respondent type -Stakeholder Opinions
survey: FSD, 2005
- Figure 2: Number of respondents per country - Stakeholder Opinions
survey: FSD, 2005
- Figure 3: US: treatment pathway for HSDD among the premenopausal and
postmenopausal clinical population, 2005
- Figure 4: US: treatment pathway for FSAD among the premenopausal and
postmenopausal clinical population, 2005
- Figure 5: UK: treatment pathway for HSDD among the premenopausal and
postmenopausal clinical population, 2005
- Figure 6: UK: treatment pathway for FSAD among the premenopausal and
postmenopausal clinical population, 2005
- Figure 7: Spain: treatment pathway for HSDD among the premenopausal
and postmenopausal clinical population, 2005
- Figure 8: Spain: treatment pathway for FSAD among the premenopausal
and postmenopausal clinical population, 2005
- Figure 9: Basson' s model of female sexual functioning
- Figure 10: Overview of some of the key limitations of existing FSD
classification systems and their implications
- Figure 11: Breakdown of respondent' s female patient population by
menopausal status in the US, UK, Spain and Germany/Italy/France, 2005
- Figure 12: Percentage of patients experiencing some degree of sexual
functioning problems in the US, UK, Spain and Germany/Italy/France, 2005
- Figure 13: Breakdown of patients with sexual functioning problems by
menopausal status in the US, UK, Spain and Germany/Italy/France (%), 2005
- Figure 14: Prevalence of female patients experiencing more than one
sexual dysfunction in the US, UK, Spain and Germany/Italy/France (%), 2005
- Figure 15: Breakdown of sexual pain in premenopausal patients by pain
subtype and country in the US, UK, Spain and Germany/Italy/France (%), 2005
- Figure 16: Breakdown of sexual pain in postmenopausal patients by pain
subtype and country in the US, UK, Spain and Germany/Italy/France (%), 2005
- Figure 17: Estimated percentage of patients with sexual functioning
problems who are reported to also suffer from other conditions in the US,
UK and Spain, 2005
- Figure 18: Summary of most significant barriers to presentation or
help-seeking for sexual functioning problems among women in the US, UK,
Spain and Germany/Italy/France, 2005
- Figure 19: Top 10 reported symptoms or complaints presented by
patients in the US and Europe, 2005
- Figure 20: Percentage of respondents who conduct routine screening for
sexual functioning problems by country and physician specialty, 2005
- Figure 21: Percentage of female patients screened for sexual
dysfunction by respondents who carry out routine screening by country, 2005
- Figure 22: Percentage of patients screened for FSD by respondents, by
co-morbid or associated condition in the US, UK, Spain and
Germany/Italy/France, 2005
- Figure 23: Summary of evaluation tools and techniques used to diagnose
FSD among all respondents in the US, UK, Spain and Germany/Italy/France,
2005
- Figure 24: Mean percentage of all respondents using various guidelines
in the US, UK, Spain and Germany/Italy/France, 2005
- Figure 25: Mean percentage of respondents reporting use of each
diagnostic guideline in the US, 2005
- Figure 26: Mean percentage of respondents reporting use of each
diagnostic guideline in Spain, 2005
- Figure 27: Mean percentage of respondents reporting use of each
diagnostic guideline in the UK, 2005
- Figure 28: FSD treatment options
- Figure 29: Average percentage of female patients with sexual
dysfunction receiving each treatment approach by region, 2005
- Figure 30: Percentage of patients receiving non-drug therapy options
for female sexual dysfunction by country, 2005
- Figure 31: Treatment of premenopausal HSDD by therapeutic approach and
country (%), 2005
- Figure 32: Treatment of postmenopausal HSDD by therapeutic approach
and country (%), 2005
- Figure 33: Treatment of premenopausal FSAD by therapeutic approach and
country (%), 2005
- Figure 34: Treatment of postmenopausal FSAD by therapeutic approach
and country (%), 2005
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