Female Sexual Dysfunction 2 Flashcards
Identify the multifactorial causes of FSD.
1
Q
What are the components of sexual desire?
A
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Biological: Drive
- spontaneous sexual interest, relative but declines with age
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Cognitive: Expectations, beliefs, and values
- is sex “acceptable”?
-
Emotional: Motivation
- interpersonal
- willingness to engage, most important!
2
Q
What is the differential diagnosis for female sexual dysfunction?
A
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Hormonal endocrine dysfunction
- estrogen
- testosterone
-
Vascular disease
- atherosclerosis
- trauma
- hypoestrogenism
-
Muscular disease
- pelvic prolapse
- vaginismus
-
Neurologic disease
- trauma
- diabetes
3
Q
What are some common findings in female sexual interest/arousal disorder?
A
- Absent/decreased sexual interest
- Absent/decreased erotic thoughts or fantasies
- Absent/decreased activity in:
- initiationof sexual activity or responsiveness to a partner’s attempts to initiate it
- excitement and pleasure
- response to sexual cues
- sensations during sexual activity,
- whether genital or non-genital
4
Q
What are medications that impact desire and arousal?
A
- Psychotropics
- Cardiovascular . Antihypertensives
- Hormonal medications
- Histamine blockers
- Antifungals
- Indomethacin
- Anticholinergics
5
Q
What are some cardinal features of sexual aversion disorder?
A
- Persistent/recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.
- Causes marked distress or interpersonal difficulty.
- Not better accounted for by another Axis I disorder (except another Sexual Dysfunction).
6
Q
What are some important features of orgasmic disorder, including the DSM definition?
A
- 5-15% of women never have an orgasm (anorgasmia)
- Usually the result of sexual inexperience, performance anxiety or past experiences that have led to inhibition of the sexual response
- Unlike men, in women, orgasm is a learned, not an automatic response
- Hormones not implicated
-
DSM V definition:
- absence, infrequency or delay of orgasm
- reduced intensity of orgasm
7
Q
What is the treatment for orgasm disorder?
A
- Viagra (subjective vs objective arousal)
- Vibrator/Masturbation therapy
-
Kegel Exercises
- strengthen PC muscle, contract/relax 5 seconds, 10-15 times 3x/day…up to 200 repetitions per day)
- greater ease in achieving orgasm, increased intensity of orgasm, increased lubrication, heightened control over sensation during penetration, and protection against urinary incontinence and bladder prolapse.
- EROS Therapy Device
- Sexual Therapy/Psychotherapy
8
Q
What is dyspareunia and vaginismus?
A
- Dyspareunia = Recurrent/persistent genital pain associated with sexual intercourse in either a male or a female.
-
Vaginismus = Recurrent/persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
- most common in pre-menopausal women
- may be fear-based particularly with women who have a history of
9
Q
What are the DSM V criteria for gento-pelvic pain/penetration disorder?
A
- Inability to have vaginal intercourse/penetration
- Vulvovaginal or pelvic pain during vaginal intercourse/penetration attempts
- Fear or anxiety either about vulvovaginal or pelvic pain or vaginal penetration
- Tensing or tightening of the pelvic floor muscles during attempted vaginal penetration