Lecture 13: Female Sexual Disorders Flashcards
What are the 4 stages of sexual response?
- Desire/libido
- Arousal (lubrication + swelling)
- Orgasm (release + rhythmic contractions)
- Resolution (Detumescence of genitals)
When does the uterus return to its original position in the sexual response cycle?
Resolution stage
What hormones excite female sexual response?
- Estrogen
- Testosterone
- Dopamine
- NE
- Oxytocin
- Melanocortins (Vyleesi)
What hormones inhibit female sexual response?
- Serotonin (high levels)
- Prolactin (milk)
- Opioids (sleepy)
- Endocannabinoids (imagine weed mellowing you out, idk)
Ifeel like just memorize these and assume everything else excites
The average age of puberty for a females ranges between…
8-13
The least common sexual disorder for females is…
Orgasm difficulties
Geographically, the area with the highest rate of sexual dysfunction among females is…
SE asia
Lowest is N europe
rip asians
The MC sexual disorder for females is
Low sexual desire
Female sexual interest/arousal disorder is a problem with 1 of 2 things:
- Low sexual desire
- Abnormal arousal response
Either emotional/physical or with lubrication/swelling
In order to be diagnosed with female sexual interest/arousal disorder, you must meet 3 general criteria:
Not the 6 symptom criteria
- Occurs 75% of the time
- Occurring for over 6 months
- Causes distress
i think this applies to all sex disorders
You hear the following statements from your female patient:
- I couldn’t care less if we never have sex again
- I’m just not interested in sex. I don’t even think about it unless my partner brings it up.
- I try to be with my partner, but I feel nothing during sex.
This patient could have….
Female sexual interest/arousal disorder
6 Symptom criteria make up Female sexual interest/arousal disorder, which are:
You must mee 3/6
- Interest in sex
- Fantasizing
- Initiation of sexual activity
- Interest/arousal to stimuli
- Excitement/pleasure
- Genital/nongenital sensations
All of which are reduced or absent interest
Female genitopelvic pain/penetration disorder encompasses problems within 3 areas, which are:
- Vaginismus (involuntary spasms)
- Vulvar pain/vestibulodynia
- Dyspareunia (pain with penetration/sex)
The 3 general criteria for genitopelvic pain/penetration disorder are:
Same as female sexual interest/arousal disorder
- Occurs 75% of the time
- Occurs 6+ months
- Causes distress
You hear the following statements from your female patient:
- I have burning pain with any penetration, even a tampon
- Anytime my partner tries to enter me, I close up down there and it hurts
- I want to be with my partner, but it’s uncomfortable. I dread him being in me
You suspect she has…
Genitopelvic pain/penetration disorder
In order to be diagnosed with female genitopelvic pain/penetration disorder, you must meet at least 1 of these 3 symptom criteria, which are:
- Vulvovaginal or pelvic pain during penetration
- Fear/anxiety about vulvovaginal pain or pelvic pain in anticipation of, during, or because of penetration
- Tensing/tightening of pelvic floor muscles during penetration attempt
Must be vaginal penetration
What history is common in females with genitopelvic pain/penetration disorder?
Sexual or physical trauma/abuse
Female orgasmic disorder tends to deal with…
- Frequency
- Intensity
- Achievement
orgasmic response
You hear the following statements from your female patient:
- I still want to be with my partner, but sex just isn’t as enjoyable as it used to be
- I enjoy sex, it feels great, but I don’t respond to it like I should
- When I finish, I barely feel anything
You suspect she has…
Female orgasmic disorder
The symptom criteria (3) for female orgasmic disorder are…
- Delayed, infrequent , diminished, or absent orgasm response
- Distress or interpersonal problems 2/2 orgasmic dysfunction
- Absence of disorder or substance
The criteria to diagnose substance/medication-induced sexual disorder include: (3)
- Significant disturbance in sexual function
- Occurring during/soon after exposure to a med or substance intoxication/withdrawal
- Absence of other symptoms/signs that suggest something else
The top 2 medication classes that result in sexual dysfunction are…
- SSRIs (up to 70%)
- TCAs
NO SNRIs!!!
too much serotonin = inhibitory i think
What kind of antipsychiatrics are NOT associated with sexual dysfunction?
Dopaminergics or selective serotonergics
Mirtazapine, bupropion, venlafaxine, duloxetine
Also buspirone
Anticholinergics can reduce this part of the sexual response…
Arousal and lubrication
because they inhibit your secretions
Which antiHTNs can cause sexual dysfunction?
- BBs
- Clonidine
- Methyldopa
Which substances can impair sexual function?
- Nicotine
- Alcohol
- Opiates
Marijuana does not affect function!!!! only sperm
What 3 organ systems, if dysfunctional, can affect sexual function as well?
- Endocrine
- Vascular
- Neurologic
Also urinary too i guess
Generally, are hormone tests good for evaluating sexual dysfunction?
Eh, usually NOT helpful
First-line tx for menopausal vulvovaginal atrophy
Estrogen
You would give it if sexual dysfunction is 2/2 menopausal symptoms
What is the consensus on using androgens for sexual dysfunction?
Not generally recommended
You also need lower dosages than a male patient would take.
In premenopausal women, the FDA approved tx for low sexual desire/libido is….
Flibanserin/Addyi
body-ody-ody-ody (megan thee stallion)
The MOA of flibanserin/addyi is…
5HT-1a agonist/5HT-2a antagonist
1 a in agonist, 2 as in antagonist
100mg tablet QHS
The SEs of flibanserin/addyi include hypotension, dizziness, and fainting, which are exacerbated if a patient takes…
Alcohol
Why is bupropion used off-label for sexual dysfunction?
Its MOA is to inhibit the reuptake of NE and dopamine, which are both excitatory hormones
Two disorders are absolutely contraindicated with bupropion usage, which are…
- Seizure disorder
- Eating disorder
PDE5 inhibitors, specifically sildenafil, are useful in women suffering specifically from…
SSRI-induced sexual dysfunction
Also neuro disorders
The main difference in regards to SE between Bremelanotide/Vyleesi and Flibanserin/addyi for premenopausal women with low libido is…
The FDA-approved tx for premenopausal women
No alcohol exacerbation in bremelanotide/vyleesi
What is the MOA of Bremelanotide/Vyleesi?
Melanocortin receptor agonist in the brain
How is bremelanotide/vyleesi dosed?
SC injection 45m before sexual activity
PRN dosing, better in older pts
Non-pharm tx of female orgasmic disorder include: (3)
- Sexual devices
- Directed masturbation
- Genital cosmetic procedures
What is the LAST resort tx for GU syndrome of menopause due to cost and limited efficacy?
Vaginal laser/radiofrequency
After conservative tx like pharm or cream for GU syndrome of menopause, you should recommend a patient to…
Pelvic floor PT
The mainstay of tx for vaginismus is…
PT + tx underlying psych issue
The initial approach to tx of vulvodynia is…
- Removal of irritating agent
- Promotion of good vulvar hygiene
ORAL MEDS ARE NOT FIRST LINE
