Female sexual dysfunction TOG 2021 Flashcards
To qualify as a dysfunction how often most sexual dysfunction occur over what period of time
75 time for 6+ moths causing significant distress
3 main categories of female dysfunction according to DSM-5
Desire/arousal disorder
Female orgasm disorder
Genito-pelvic pain/penetration disorder (merged dyspareunia and vaginimis)
Most common sexual problem
Lack of interest in sex
Rate of persistent dyspareunia with operative vaginal delivery at 12 months
14%
Rate of persistent dyspareunia with SVD with intact perineum delivery at 12 months
3.4%
Does method of hysterectomy affect long term sexual function?
No similar outcomes Lap/Vag/open.
No difference total/subtotal;
Oopherectomy - poorer sexual outcomes in premenopausal women with BSO
Management vaginismus
CBT
Vaginal dilator use
Lubricants
Pelvic floor phsiotherapy
Relaxation
Women with breast cancer talking which medications are highly likely to suffer FSD
Aromatase inhibitor
Altnerative for topical oestrogen for dyspareunia secondary to vulvovaginal atrophy
Ospemifene - selective estrogen receptir modulatiot - CI similar - breast cancer, endometrial hyperplasia, HX VTE
What hormones does tibolone replace? highest risk with tibolone
Synthetic steroid - estrogenic, progestogenic and androgenic properties
Higher risk of stroke than other HRT
Side effects of long term testosterone replacement
Alopecia
Hirsutism
Acne
Breast pain
increased CV disease
insulin resistence
metabolic syndrome
When does NICE recomend testosterone use?
Low sexual desire despite HRT
When does the American college of O&G advise testing testosterone levels
After 3-6 months to ensure testosterone levels within normal range, retest every 6 months if continuing therapy
Which drug has been shown to be beneficial in FSD secondary to spinal cord injury and SSRI use? What is the mechanism?
Slidenafil (viagra)
- Increases cGMP, smooth muscle relaxation, genital engorgement
What is the use of dopamine agonist in FSD?
Can be used with hypoactive desire disorders
Cabergoline - FSD secondary to antipsychotic induced hyperprloactinaemia
Describe use of fibanserin in FSD
Serotonin 1a agonist/2aantagonist
Acts central to influence mood/behaviour
FDA approved hypoactive desire disorder, systematic review found no improvement and high amount of adverse effects - dizzy/nausea/fatiqgue
Must abstain from ETOH to avoid hypotension/syncope
What surgical procedure can be offered to dyspareunia from narrowing/skin splitting in posterior forchette following obstetric scarring? Outcomes at 12 months
Fentons procedure
60% complete relief
39% moderate relief
Success of triggers point injections to elevator ani muscle spasm
72% at 3 months
