231. Female Sex Dysfx Flashcards
What are the 4 components of sexual response?
What biological molecules play a role? Which type plays more of a role?
- Libido
- Arousal
- Intercourse
- Orgasm
NTs: MAJOR players, regulate excitatory/inhibitory mediations of sexual desire/arousal and orgasm/satisfaction
Hormones: prime brain for NT response, prime genitals to respond to sexual stimuli, maintain genital structure/fx (Supportive role)
Libido
- define
- inhibitory signals
- excitatory signals
- where is the limbic system? what is its fx?
- Hormones?
- where is the main regulation of libido?
L: desire to have sexual activity, sexual thoughts/images/wishes
Inhibitory: 5HT, PRL, Opioids
Excitatory: DA, NE, Melanocortin, E, T
Limbic System: at top of brainstem, fx for emotions, motivations, pleasure; modulated by DA/NE (excitatory!) to influence PNS (includes hypothalamus signaling to pit = hormonal regulation)
Pre-frontal Cortex: regulates compulsive-reward-seeking behavior (INHIBITORY), modulated by 5ht (INHIBITORY)
Hormones: Ant pit: LH/FSH (control androgen/E production), hormone receptors in hypothalamus prime pump to respond more to NTs, androgens/T peaks midcycle but no correlation to sex fx
HIGH CENTRAL REGULATION
LOW HORMONAL REGULATION
NO CORRELATION WITH GENITAL FX
Arousal
- define
- stimuli
- inhibitory/excitatory signals
- CP
- where is the main regulation of arousal?
A: subjective sense of self-pleasure with PHYSIOLOGIC changes (high HR, BP, RR, low appetite, genital engorgement)
Stim: brain (visual, auditory, olfactory, fantasy), physical touching of erogenous zones (lips, clitoris, labia, tongue, nipples/breasts)
Excitatory: DA, NE, NO, ACh, E, Androgens
Inhibitory: 5HT, PRL
CP: clitoral enlargement, vaginal tenting, perivaginal arterial dilation, vaginal mucosa lubrication, vaginal elongation
HIGH CENTRAL, HORMONAL, AND GENITAL REGULATION
Intercourse
- under what control?
- what is required for proper fx?
Physical control: pelvic floor muscles
Vagina: must be lubricated and elastic
- requirements: adequate blood supply (lubricant is transudate), collagen, fibrin
UNDER END ORGAN PHYSICAL REGULATION ONLY (no central/hormonal slightly by E/T)
Orgasm
- what is it
- hormone
- pathways
- requirements
- under what control?
Sensation of intense pleasure creating altered consciousness with uterine contractions, anal contractions, pelvic m. contractions - resolves sexually-induced vasocongestion and induces well-being/contentment
Hormone: OXYTOCIN - signal from PVN of hypothalamus to secrete from post pit during arousal and orgasm, works synergistically with sex hormones to facilitate muscle contractions
Paths:
- Primary: Clitoral Stim = SC = Brain
- Alternate: Vagina/Cervix Stim = Vagus/Pelvic N = Brain (avoid SC)
ONLY 10-30% women achieve orgasm during penile-vaginal intercourse (LOW)
Requirements:
- Arousal: physical/emotional stim of erogenous zones
- Physical stim: usually clitoral contact
- Adequate blood flow (muscle/clitoral congestion, clitoral nerves)
- Intact Neuro System (>8000 nerve endings in clitoris stim SC/brain)
Regulated: CENTRALLY, END ORGAN PHYSICAL (no hormones)
Female Sex Dysfx
- define
- prevalence
- cause
- drugs assoc w/ FSD
Disturbance causing MARKED distress or interpersonal difficulty
Prev: 43.1% women with sexual problem, 11.5% with distressing sex problem (FSD)
Cause: Multifactorial (Bio-Pharm, Socio-cultural, Psych)
Drugs
- Alcohol
- OCPs
- SSRIs
Hypoactive Sexual Desire Disorder
- define
- category
- prevalence
- cause
Anorgasmia
- define
- categorise
- types
- RFs/most frequent cause
HSDD: persistent/recurrent deficiency/absence of sexual thoughts, fantasies, desires for sexual activity causing personal distress or interpersonal difficulty
- desire/arousal disorder
- prevalence: low desire increases with age, but disorder decreases with age due to it being less distressing
- cause: multifactorial
Anorgasmia: causing MARKED distress/difficulty
- Primary: never had orgasm, E: most just need map, trauma, cultural conditioning, partner hostility, dyspareunia
- Secondary: acquired inability to have orgasm in woman previously orgasmic, something not functioning appropriately
- RF: vascular disease (atherosclerosis, DM), Neuro disease (DM neuropathy, MS/SC injury, surgical nerve damage), pelvic floor integrity, Gyne conditions (lichen sclerosis, VVA)
- MOST FREQUENT CAUSE: SSRI USE!!!
Dyspareunia: define, types
Define Apareunia
What is a cause of dyspareunia?
Dyspareunia: pain during intercourse
- Superficial: pain on entry (E deficiency, GYN condition, impaired vaginal lubrication due to mp, OCPs, postpartum, chemotx, DM, Atherosclerosis, IVF)
- Deep: pain after entry (endometriosis, PID, pelvic floor dysfx, pelvic organ prolapse, fibroids)
Apareunia: inability to have intercourse
