Female Sexual Disorders (Made by Billie) Flashcards
what are the four stages of sexual response
- Desire (libido) - intent to be sexually intimate
- Arousal - lubrication and swelling (vascular congestion) of genital tissue
- orgasm - release of tension, rhythmic contractions of reproductive organs & pelvic floow
- resolution - detumescence of genitalia & subjective sense of satisfaction
what has have excitatory hormonal effects
- estrogen
- testosterone
- dopamine
- NE
- oxytocin
- melanocortins
what has inhibitory hormonal effects
- serotonin (high levels)
- prolactin
- opioids
- endocannabinoids
During puberty, what things do variations of libido and sexual activity depend on?
- mental health
- relationship status
- societal/cultural/family norms
- phase of menstrual cycle
what is the primary goal in education for sex with puberty aged females
set healthy expectations for sexual activity
what is the biggest influence on sexual desire and satisfaction in perimenopausal or postmenopausal women? what other things may influence these
fluctuating hormones!!!
also insecurities about aging!
True or false: postmenopausal women alway shave decreased sexual desire/satisfaction
false!! some note increased sexual desire and satisfaction
what percentage of women experience some type of sexual dysfunction
43%
highest = SE asia
Lowest = europe
what is the MC stage of sexual response that causes dysfunction
Desire!
39% of US females
from MC to least common, list the areas of sexual dysfunction
- low sexual desire
- Low arousal response
- sex-related personal distress
- Orgasm Difficulties
what possible psychosocial issues can lead to sexual dysfunction
- relationship factors
- fatigue/stress
- substance use
- psychiatric disorders (including meds)
- hx of abuse or negative experiences
what Gynecological conditions can lead to sexual dysfunction
- pregnancy/childbirth
- endometriosis
- pelvic organ prolapse
- GU syndrome of menopause
what chronic medical conditions can lead to sexual dysfunction
- CVD
- endocrine disease
- neurologic disease
what is female sexual interest/arousal disorder
problems w low sexual desire or abdormal arousal response
emotional/mental or lubrication swelling
what is the criteria for diagnosis of female sexual interest/arousal
- must occur >75% of the time
- must occur for 6+ months
- must cause distress!!!
- Must include at least 3/6 from the following:
what is genitopelvic pain/penetration disorder
problems with either vaginismus, vulvar pain/vestibulodynia or dyspareunia
what is vaginismus
involuntary vaginal spasm
what is dyspareunia
pain w penetration or sexual activity
what is the criteria for genitopelvic pain/penetration disorder
- > 75% of the time
- 6+ months
- causes distress
- one or more of the following:
what is commonly found in the hx of a patient with genitopelvic pain/penetration disorder
hx of sexual/physical trauma or abuse:(
what is female orgasmic disorder
problems with frequency, intensity or achievement of orgasm response
what is the criteria for female orgasmic disorder
- > 75% of the time
- 6+ months
- causes distress
- one of the following:
what is substance/medication-induced sexual disorder
medication/substance related affect of desire, arousal, orgasm or any other parameter of normal sexual function
what is the criteria for substance/medication-induced sexual disorder
- significant disturbance in sexual function
- disturbance occurred during or soon after exposure to medication/substance
- absence of other s/s that would better explain the dysfunction
what is the leading culprit for substance/medication induced sexual disorder
psychiatric medications
general overview of psychiatric medications effects on sexual function
which antidepressents are related to sexual dysfunction
- SSRIs
- TCAs
SNRIs are NOT associated
which anxiolytics are and are not associated with sexual dysfunction
- BZDs are
- buspirone is not
what effect do anticonvulsants have on sexual function
decreased libido
aside from psychiatric medications, what other medications can negatively affect sexual function
- anticholinergics (antihistamines/antispasmodics)
- antihypertensives (BB, clonidine, methyldopa)
- hormonal agents
what substances of abuse can impact sexual function
- nicotine - limits sexual arousal
- alcohol - hypogonadotropic state; impaired overall fxn
- opiates - hypogonadotropic state; impaired overall fxn
- marijuana - does not harm function but overall negative impact on
how can infertility impact sexual function
sex may become a chore associated with disapointment:(
what four body systems are associated with sexual function
neurologic, vascular, urinary and endocrine
When is estrogen rx helpful in sexual disorders
- menopausal VVA
- improves libido, arousal response, pain secondary to vaginal atrophy
- improves clitoral sensitivity
what are SE of estrogen
- liver disease
- endometrial hyperplasia and cancer
- VTE events
what medication is approved for premenopausal patients with low sexual desire/libido
- flibanserin (addyi)
- bremelanotide
what is the MOA of flibanserin (Addyi)
5HT-1a agonist/ 5HT-2a antagonist
causes decrease in 5HT and increase in NE/dopamine in regions of brain
what are the SE of flibanserin
hypotension, dizziness, fainting
SE worse w alcohol. can also see nausea, fatigue, sleepiness or insomnia
what are CI to flibanserin
- alcohol
- hypotension
what is the MOA of bupropion
NE and dopamine reuptake inhibitor
what tx has primary benefit seen in women w SSRI induced sexual dysfunction
PDE-5 inhibitors (off label)
sildenafil, tadalafil, vardenafil
what is the MOA of bremelanotide (Vyleesi)
- agonist on melanocortin receptors in the brain
what are non pharmacologic treatment options for female orgasmic disorder
- sexual devices
- directed masturbation
- genital cosmetic procedures
what is GU syndrome of menopause
Pain secondary to hypoestrogenism and subsequent atrophy of GU tissues
how do you treat GU syndrome of menopause
