AMA Guides® Newsletter - Issue Archive

Articles

1. Assessing Sexual Dysfunction Part 2: Female Sexual Dysfunction

   Seth D. Cohen, Steven Mandel, David B. Samadi

   Pages 3–8

   DOI: 10.1001/amaguidesnewsletters.2016.MayJun01

   Abstract

   Sexual dysfunction is more common in women (43%) than men (31%), and the evaluating physician must consider the individual's chronological and physiologic age, personal and interpersonal sexual experiences, life events, and relationship issues that may have an effect on female sexual health. The medical history should include focused questions about medical and/or surgical illnesses, use of medications, and urogynecological history. Validated, reliable, standardized questionnaires are useful to identify the presence or absence of various domains of female sexuality such as sexual desire, sexual arousal, orgasm, and/or sexual pain (eg, the Female Sexual Function Index). Serum hormone testing should be dictated by clinical suspicion, and the physician also may assess multiple androgen and estrogen values, as well as pituitary function and levels of thyroid stimulating hormone. Systemic androgens (eg, systemic dehydroepiandrosterone and/or systemic testosterone) may improve mood, energy, stimulation, sensation, arousal, and orgasm in women with sexual health concerns. Combining a biomedical and psychosocial approach to any kind of sexual dysfunction helps to optimize patient outcomes. In the case of hypoactive sexual desire disorder (HSDD), individual or couples-based therapy with a sexual health therapist should be part of the consultation. If the biologic basis of the sexual health concern can be diagnosed by history, physical examination, laboratory testing, and directed imaging studies, then management can be directed to evidence-based management strategies.
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2. Impairment Assessment of Female Sexual Dysfunction

   Christopher R. Brigham, Randolph Soo Hoo

   Pages 8–9

   DOI: 10.1001/amaguidesnewsletters.2016.MayJun02

   Abstract

   Impairment assessment of female sexual dysfunction using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth or Sixth Edition, must be performed using appropriate evaluation and objective findings to support ratable sexual dysfunction. In both editions, sexual dysfunction is discussed in Chapter 7, The Urinary and Reproductive Systems, and Chapter 13, The Central and Peripheral Nervous System. In the fifth edition, the maximum impairment rating for female sexual functioning is 35% whole person impairment; in the sixth edition, the maximum is 20%. In terms of rating female reproductive organ impairment, the fifth edition gives consideration to the differences between premenopausal and postmenopausal women. Table 7-9, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease in the fifth edition is used to rate female sexual dysfunction; three classes are identified, and, although age is not a specific consideration, this edition discusses differences between premenopausal and postmenopausal women. In the AMA Guides, Sixth Edition, Table 7-10, Criteria for Rating Permanent Impairment Due to Vulval and Vaginal Disease, is used and provides four classes, two of which have severity grades. Each class addresses historical signs and symptoms of vulvar or vaginal diseases, vulval and vaginal physical alterations, and potential effect of altered vaginal anatomy for vaginal delivery (if premenopausal). Neurogenic sexual dysfunction is combined with other related impairments using the Combined Values Chart.
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3. Carpal Tunnel Syndrome and Trigger Fingers in a Patient with Rheumatoid Arthritis and Systemic Lupus Erythematosus: Case Example

   Christopher R. Brigham, J. Mark Melhorn, Charles N. Brooks, Steven D. Feinberg, James B. Talmage

   Pages 10–14

   DOI: 10.1001/amaguidesnewsletters.2016.MayJun03

   Abstract

   Causation analysis involves determining what conditions are related to a compensable injury or illness; apportionment is the allocation of responsibility among two or more probable causes; and assessing impairment is based on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). These three are separate activities, but sometimes all three must be addressed in a single evaluation and may be required for a specified jurisdiction (eg, California). Evaluators thus must ask if jurisdictional issues dictate or influence the approach to causation and apportionment; which edition of the AMA Guides to use; and how to approach causation and apportionment in the present case example: A 63-year-old woman with rheumatoid arthritis and systemic lupus erythematosus is assessed by an orthopedic surgeon who is the agreed medical evaluator (AME). In addition to her pre-existing rheumatoid arthritis and lupus, the individual also had Sjogren's syndrome, osteoarthritis, degenerative disc disease, left carpal tunnel syndrome, osteopenia, and obesity. She has undergone multiple surgical procedures, and treatment for her collagen vascular disease includes leflunomide (immunosuppressant), hydroxychloroquine, and prednisone. In this case, impairments were not the result of “cumulative trauma” but rather were secondary to underlying chronic inflammatory disease, and her occupational permanent impairment rating accordingly would be zero.
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4. Q&A: Ratings Based on Functional Capacity Evaluations

   Christopher R. Brigham, James B. Talmage

   Pages 15–16

   DOI: 10.1001/amaguidesnewsletters.2016.MayJun04