15 - Femal Sexual Response

Question 1

Sexual response cycle?

Answer 1

Drive
Arousal
- subconscious
- autonomic nervous system
- subjective  (blood flow and fluids and stuff)
Emotional modulators

Question 2

Pregnancy/postpartum variations of psyiologic sex response?

Answer 2

Fatigue
Hormone changes
Breast feeding
- decreases sex satisfaction
Method of delivery

Question 3

Menopause variations on sex response?

Answer 3

Hypoestrogenic state

- more to follow in chapter 18

Question 4

Sexual dysfunction stats?

Answer 4

64% - low/no sex desire
35% - difficulty w orgasm
26% - sexual pain

Generally last <6 mo

Question 5

Psychiatric sexual dysfunction

Answer 5

Painful intercourse
Disturbance in
- desire
- arousal
- orgasm
- resolution

Question 6

Sexual dysfunction types?

DSM-5

Answer 6

Female sexual interest/arousal d/o
Female orgasmic d/o
Genitopelvic pain/penetration d/o
Substance/medication-induced sex dysfunction
Other 

Can be

• lifelong - acquired
• generalized - situational

Question 7

Psychosocial risk factors for sexual dysfunction?

Answer 7

Comorbid psych d/o
Neg emotions
Maladaptive conditions
Cultural factors
Lack of sex ed
Couple distress
Physical attraction

Question 8

Phases of sexual response

Answer 8

Desire (libido) - testosterone
Excitement (arousal) - estrogen
Orgasmic - sympathetics

Question 9

Desire (libido) is moderated by?

Answer 9

Testosterone

• excited by dopamine
• suppressed by serotonin

Hypoactivity - 65% of all sexuality issues

Question 10

Excitement phase is affected by?

Answer 10

Modulated by parasympathetics

Enhanced by estrogen

Question 11

Excitement extragenital effects?

Answer 11

HR, 
BP 
muscle tension
Breast size
Areolar engorgement
Nipple erection
Sex flush (75%)

Question 12

Most treatable sexual phase d/o?

Answer 12

Orgasmic phase

• its modulated by sympathetics
• optimized by clitoral input

Question 13

Risk factors for dyspareunia?

Answer 13

Age <50:

• sexual abuse
• hx of PID
• Depression
• anxiety

Question 14

What is vaginismus?

Answer 14

Involuntary contraction of outer 1/3 of vaginal muscles

Question 15

Sexual dysfunction w/u?

Answer 15

Hx is key
Eval for physical cause
Eval for psych d/o

Question 16

Sex dysfunction tx approach?

Answer 16

Multidisciplinary tx team

• load the boat
• gyn, psych, nurse-specialist
• and organic - urology, GI, etc

Question 17

Psychological approaches dysfunction tx?

Answer 17

Combo of

• sex ed
• communication enhancement
• ID emotional/cultural factors
• cognitive-behavior therapy
• couples therapy

Question 18

Prevalence of domestic violence?

Answer 18

ER sampling
54% - lifetime
24% - current partner

Question 19

Sexual assault definition?

Answer 19

Any sexual act w/o consent

• threat/force
• even includes viewing of porn

Question 20

Sexual assault stats?

Answer 20

Incidence

• 20% under 21 y/o
• 13-39% lifetime

Perpetrators
- 75% know their victim

Injuries

• 70% - no obvious inj
• 24% - minor inj
• 5% - serious inj

Death is rare but fear of death is common

Question 21

PE for sexual assault?

Answer 21

Use SANE if available 
Follow the checklist
Get consent for exam
Chaperone - have one
Law enforcement - notification 
- restricted vs unrestricted reporting

Question 22

Tx for sexual assault

Answer 22

Injury tx

STD prophylaxis

• GC, non GC
• HBIG/Hep B
• HIV prophylaxis (dependent on risk)

Emergency contraception

• pan B
• anti-emetic

Question 23

Care after sex assault?

Answer 23

Mental health/counseling referral

Follow up
- 1 week of prophylaxis given
- 2 week if no prophylaxis
(Repeat GC and non-GC)

Other

• syphilis q 6 wks
• HIV 6,12,24 wks

Dont forget safe place to go, transportation etc

Question 24

Rape trauma syndrome?

Answer 24

Psychologic sequelae

acute/disorganization phase

• hours - days
• distortion/paralysis of coping mechanism

Integration/resolution phase

• months - yrs later
• flashbacks, nightmares, phobias
• gyn/mensural complaints

PTSD

• 50% of rape victims
• Mitigate w acute crisis counseling

Question 25

Diagnostic criteria for PTSD?

Answer 25

Sx x 1 month
Exposure to trauma
Re-experience of trauma
Avoidance of the trauma
Increased arousal
Life dysfunction

Question 26

sex jokes are not funny. Period!

Answer 26

Bruh! Its not funny i mean cum on people