Kelly, Christine DNP Project

Christine Kelly, DNP, MSN

DNP: California State University, Fresno

Project Title: Does the implementation of a sexual health tool during a well-woman exam increase the diagnosis of sexual dysfunction?

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Background: Sexual health is an evolving topic and was recently defined by WHO as “a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity”. It is important to address sexual health with individuals as it is crucial for their overall well-being. Sexual health encompasses physical, emotional, mental, and social health. Breakdowns of these aspects can lead to poor relationships, potentially affecting the patient physically and emotionally. Organizations such as the International ISSWSH, National Coalition for Sexual Health, and NPWH have brought women's and sexual health to the forefront, yet there is no standard in current practice.

Purpose: The DNP project aims to address the question, does the implementation of a sexual health tool help increase the diagnosis and treatment of sexual dysfunction? The purpose of this project is to increase the identification and treatment of sexual dysfunction in female patients, which has the potential to improve quality of life and compliance with disease management.

Methods: This study is a quantitative quality improvement (QI) project using a correlational research design and secondary data. A data analyst helped retrieve ICD-10 codes through data mining to protect privacy. The FSFI6 tool was utilized as it typically takes less than 2 minutes to complete and score, and has previously been studied and validated in determining women at risk for sexual dysfunction.  After an all-staff meeting, the tool was implemented in a private practice where instructions were provided. The study took 3 weeks to complete. Data was looked at in 2-week intervals before and after implementation of the tool to see if there was an increase in sexual health diagnoses after implementation with well-woman exams. 

Results: A chi-square test of independence was conducted to examine the association between the groups and a diagnosis of sexual dysfunction. The expected frequencies were below five at 4.75. Thus, Fisher's exact test was also run. There was a statistically significant association between the groups and a sexual dysfunction diagnosis. 𝑥2 (1, N=158) =7.74, p=0.005. Fisher's exact test and 𝑥2had very similar results, with Fisher's test giving a p-value of p=0.007. This is within 0.002 of the chi-squared test, showing that both tests produced statistically significant and very similar results. The Cramer's V showed a mild association, Cramer’s V=0.221. Those in the control group, 1 (1.2%), had a sexual dysfunction diagnosis, and 82 (98.8%) did not. Among those in the FSFI6 group, 9 (12%) had a sexual dysfunction diagnosis and 66 (88%) did not.

Conclusions: The chi-squared test of independence shows that using the FSFI6 during well-woman exams does increase the diagnosis of sexual dysfunction. The FSFI6 tools showed 14 patients had a score of 19 or lower, but only nine patients had a sexual dysfunction diagnosis in combination with well-woman exams. Leaving five patients without a diagnosis, who most likely should have had one. This may indicate that there may be other factors and variables that inhibit the diagnosis of sexual health dysfunction.

Standardized screening can increase access to diagnosis and treatment and improve overall health for women in our population. This study can have future implications for practice by showing the correlation and benefits of standard screening to improve diagnosis while not impacting the current workflow for healthcare clinicians. 

Project Chair