Female Sexual Disorders - Exam 3 Flashcards
What are the 4 stages of sexual response?
stage 1: Desire (Libido): intent to be sexually intimate
stage 2: Arousal: Lubrication and swelling (vascular congestion) of genital tissue
stage 3: Orgasm: Release of sexual tension,
Rhythmic contractions of reproductive organs, pelvic floor
stage 4: Resolution: Detumescence of genitalia. Subjective sense of satisfaction
What is the modified cycle of female sexual response?
What hormones have an excitatory effect on the female response?
estrogen
testosterone
dopamine
norepinephrine
oxytocin
melanocortins
What hormones have an inhibitory effect on the female sexual response?
serotonin: at higher levels
prolactin: think nursing mothers and hyperprolactinemia
opioids
endocannabinoids
What is the average age of puberty in females?
8-13 years old
What are the different options for female sexual disorders?
low sexual desire
low arousal response
orgasm difficulties
sex related personal distress
sexual pain disorders
What are some psychosocial issues that cause female sexual dysfunction?
What is the MC type of female sexual disorders? What does it encompass?
Female Sexual Interest/Arousal Disorder
Encompasses problems with either low sexual desire or abnormal arousal response
What is the criteria to qualify for a female sexual interest/arousal disorder?
Encompasses problems with either low sexual desire or abnormal arousal response (emotional/mental or lubrication/swelling)
Must occur 75% of the time or greater
Must have been occurring for 6+ months
Must cause distress for the patient
What is considered genitopelvic pain/penetration disorder? What is a common historical finding?
Encompasses problems with either vaginismus, vulvar pain/vestibulodynia, or dyspareunia
same time constraints: 75% of the time, 6+ months, distress for the pt
History of sexual or physical trauma or abuse is common!
What is vaginismus? What is dyspareunia?
vaginismus: involuntary vaginal
spasm
dyspareunia: pain with
penetration or sexual activity
What is female orgasmic disorder? What are factors that contribute?
Encompasses problems with frequency, intensity, or achievement
of orgasm response
same time constraints: 75% of the time, 6+ months, cause distress
- Psychiatric and social contributing factors
- Patient position, arousal, and adequate stimulation
- Medical conditions, including menopause
What are common causes of substance/medication induced sexual disorder?
May affect desire, arousal, orgasm, or any other parameter of normal sexual function due:
to medication INCREASE
type of medication
Disturbance occurred during or soon after exposure to a medication, or substance intoxication/withdrawal
Absence of other symptoms/signs that would better explain the dysfunction
What are the major medication culprits that lead to substance/medication-induced sexual disorder?
SSRIs: each SSRI is different for one pt so try another one!
TCAs
Anxiolytics
Anticonvulsants
Lithium or Barbiturates
anticholinergics: can reduce genital arousal and lubrication (antihistamines and antispasmodics)
antihypertensives: BBs, clonidine, methyldopa
hormonal agents: GnRH agonists/antagonists, SERMs, aromatase inhibitors
What psych meds are a better options for less sexual dysfunction? ** Which one does Jensen likes?
Dopaminergic or selective serotonergic (mirtazapine, bupropion, venlafaxine, duloxetine) - not as associated with sexual dysfunction
Jensen likes bupropion
What are substances that are commonly abused that can lead to sexual disorder?
nicotine: limits sexual arousal
alcohol
opiates
marijuana
What type of state does alcohol and opiates put you in?
hypogonadotropic state; impaired overall function
What organ symptoms that may be associated with a medical diagnosis known to cause female sexual disorders?
medical diagnosis known to affect:
endocrine
vascular
neurologic function: anticonvulsant drugs
urinary
May be a complaint of sexual-related distress that doesn’t fit other criteria
What are the gynecologic conditions that can lead to female sexual disorders?
pregnancy and postpartum
infertility
endometriosis
uterine fibroids
pelvic organ prolapse
incontinence
GU syndrome of menopause
What 3 aspects of a pt’s medical history can lead to sexual dysfunction?
chronic dz
medications
substance use
What 2 labs should you order when evaluating for female sexual disorder? What is NOT helpful?
CBC-> anemia
STI screening
hormone levels are NOT helpful
What are some general interventions that should be used in the treatment of sexual disorders?
counseling
lifestyle changes: Relieving stress/fatigue
Renewed emotional intimacy
Improving body image
pelvic floor dysfunction
usually requires complex, multifactorial cases with a trial of different treatments to find what is right for your pt
______ is the most helpful for patients with menopausal VVA. What can it help with? What type of disorder is it NOT helpful with?
Estrogen
Can improve libido, arousal response, pain secondary to vaginal atrophy and can improve clitoral sensitivity
female orgasm disorders
What are the SE of estrogen?
liver disease, endometrial hyperplasia and cancer, VTE events
**______ is NOT indicated for sexual dysfunction alone but may be helpful as adjunt
estrogen
_______ are generally NOT recommended for sexual disorders but when used, how are they dosed?
androgens (testosterone)
dosed MUCH lower than in male pt ranges
**_______ is approved for PREMENOPAUSAL patients who have low sexual desire. What is the MOA? How is it dosed?
Flibanserin (Addyi)
5HT-1a agonist / 5HT-2a antagonist: Causes transient decrease in 5HT and increase in norepinephrine/dopamine
in certain regions of the brain
aka pushed down serotonin and increases dopamine in certain areas of the brain
have to take it everyday!
What are the SEs of Flibanserin (Addyi)? What is the highlighted one? **What makes the SEs worse?
hypotension, dizziness, fainting
hypotension
**SE worse with alcohol
______ is commonly used off-label for sexual dysfunction. What is the MOA?
Bupropion (Wellbutrin, Zyban)
Norepinephrine and dopamine reuptake inhibitor
**What are the CI to Bupropion? When should you dose it?
**seizure disorder, anorexia/bulimia, hypersensitivity to rx, use of MAOI in last 14 days
possible risk of suicide in patients 18-24 years old
dose in the AM due to insomnia
What additional medications can be used in sexual dysfunction? What are the CAM options?
bupropion
flibanserin
CAM: Maca root, ginkgo biloba and saffron
When are PDE inhibitors beneficial in sexual disorders? What disorders?
primary benefit seen in women with SSRI-induced sexual dysfunction (off-label use)
slightly helpful in sexual function and orgasm but NOT helpful for desire causes
What is the general overview taken from lecture of how useful PDE inhibitors are in treating sexual dysfunction?
aka only those who need help with increased blood flow do these work for in WOMEN
______ approved for premenopausal patients with
low sexual desire/libido. What drug class?
Bremelanotide (Vyleesi)
Melanocortin Receptor
Agonists
Does Bremelanotide (Vyleesi) interact with alcohol? How is it dosed?
does NOT interact with alcohol
SC injection 45 minutes before activity and dosed PRN
What are some non-medication options for female orgasmic disorder?
Sexual Devices/Products
Directed Masturbation
Genital Cosmetic Procedures-> risk of tissue damage
What are the tx options for GU syndrome of menopause?
vaginal estrogen therapy
lubricants
vaginal DHEA or testosterone
oral ospemifene
vaginal laser/RFA
pelvic floor PT
What is the tx for vaginismus?
Physical therapy in addition to treating any underlying psychological cause is the mainstay of treatment
pelvic PT
Rx: gabapentin, TCAs, cyclobenzaprine, botox
What is the tx for vulvodynia?
Removal of irritating agent and promotion of good vulvar hygiene is the initial approach to improvement
pelvic PT
topical therapies
