Female sexual dysfunction TOG 2021

Question 1

To qualify as a dysfunction how often most sexual dysfunction occur over what period of time

Answer 1

75 time for 6+ moths causing significant distress

Question 2

3 main categories of female dysfunction according to DSM-5

Answer 2

Desire/arousal disorder

Female orgasm disorder

Genito-pelvic pain/penetration disorder (merged dyspareunia and vaginimis)

Question 3

Most common sexual problem

Answer 3

Lack of interest in sex

Question 4

Rate of persistent dyspareunia with operative vaginal delivery at 12 months

Answer 4

14%

Question 5

Rate of persistent dyspareunia with SVD with intact perineum delivery at 12 months

Answer 5

3.4%

Question 6

Does method of hysterectomy affect long term sexual function?

Answer 6

No similar outcomes Lap/Vag/open.
No difference total/subtotal;

Oopherectomy - poorer sexual outcomes in premenopausal women with BSO

Question 7

Management vaginismus

Answer 7

CBT
Vaginal dilator use
Lubricants
Pelvic floor phsiotherapy
Relaxation

Question 8

Women with breast cancer talking which medications are highly likely to suffer FSD

Answer 8

Aromatase inhibitor

Question 9

Altnerative for topical oestrogen for dyspareunia secondary to vulvovaginal atrophy

Answer 9

Ospemifene - selective estrogen receptir modulatiot - CI similar - breast cancer, endometrial hyperplasia, HX VTE

Question 10

What hormones does tibolone replace? highest risk with tibolone

Answer 10

Synthetic steroid - estrogenic, progestogenic and androgenic properties

Higher risk of stroke than other HRT

Question 11

Side effects of long term testosterone replacement

Answer 11

Alopecia
Hirsutism
Acne
Breast pain
increased CV disease
insulin resistence
metabolic syndrome

Question 12

When does NICE recomend testosterone use?

Answer 12

Low sexual desire despite HRT

Question 13

When does the American college of O&G advise testing testosterone levels

Answer 13

After 3-6 months to ensure testosterone levels within normal range, retest every 6 months if continuing therapy

Question 14

Which drug has been shown to be beneficial in FSD secondary to spinal cord injury and SSRI use? What is the mechanism?

Answer 14

Slidenafil (viagra)

• Increases cGMP, smooth muscle relaxation, genital engorgement

Question 15

What is the use of dopamine agonist in FSD?

Answer 15

Can be used with hypoactive desire disorders

Cabergoline - FSD secondary to antipsychotic induced hyperprloactinaemia

Question 16

Describe use of fibanserin in FSD

Answer 16

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

Question 17

What surgical procedure can be offered to dyspareunia from narrowing/skin splitting in posterior forchette following obstetric scarring? Outcomes at 12 months

Answer 17

Fentons procedure
60% complete relief
39% moderate relief

Question 18

Success of triggers point injections to elevator ani muscle spasm

Answer 18

72% at 3 months