Lecture 13: Female Sexual Disorders Flashcards

1
Q

What are the 4 stages of sexual response?

A
  1. Desire/libido
  2. Arousal (lubrication + swelling)
  3. Orgasm (release + rhythmic contractions)
  4. Resolution (Detumescence of genitals)
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2
Q

When does the uterus return to its original position in the sexual response cycle?

A

Resolution stage

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3
Q

What hormones excite female sexual response?

A
  • Estrogen
  • Testosterone
  • Dopamine
  • NE
  • Oxytocin
  • Melanocortins (Vyleesi)
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4
Q

What hormones inhibit female sexual response?

A
  • Serotonin (high levels)
  • Prolactin (milk)
  • Opioids (sleepy)
  • Endocannabinoids (imagine weed mellowing you out, idk)

Ifeel like just memorize these and assume everything else excites

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5
Q

The average age of puberty for a females ranges between…

A

8-13

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6
Q

The least common sexual disorder for females is…

A

Orgasm difficulties

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7
Q

Geographically, the area with the highest rate of sexual dysfunction among females is…

A

SE asia

Lowest is N europe

rip asians

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8
Q

The MC sexual disorder for females is

A

Low sexual desire

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9
Q

Female sexual interest/arousal disorder is a problem with 1 of 2 things:

A
  • Low sexual desire
  • Abnormal arousal response

Either emotional/physical or with lubrication/swelling

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10
Q

In order to be diagnosed with female sexual interest/arousal disorder, you must meet 3 general criteria:

Not the 6 symptom criteria

A
  • Occurs 75% of the time
  • Occurring for over 6 months
  • Causes distress

i think this applies to all sex disorders

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11
Q

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….

A

Female sexual interest/arousal disorder

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12
Q

6 Symptom criteria make up Female sexual interest/arousal disorder, which are:

You must mee 3/6

A
  • 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

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13
Q

Female genitopelvic pain/penetration disorder encompasses problems within 3 areas, which are:

A
  • Vaginismus (involuntary spasms)
  • Vulvar pain/vestibulodynia
  • Dyspareunia (pain with penetration/sex)
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14
Q

The 3 general criteria for genitopelvic pain/penetration disorder are:

Same as female sexual interest/arousal disorder

A
  • Occurs 75% of the time
  • Occurs 6+ months
  • Causes distress
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15
Q

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…

A

Genitopelvic pain/penetration disorder

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16
Q

In order to be diagnosed with female genitopelvic pain/penetration disorder, you must meet at least 1 of these 3 symptom criteria, which are:

A
  • 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

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17
Q

What history is common in females with genitopelvic pain/penetration disorder?

A

Sexual or physical trauma/abuse

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18
Q

Female orgasmic disorder tends to deal with…

A
  • Frequency
  • Intensity
  • Achievement

orgasmic response

19
Q

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…

A

Female orgasmic disorder

20
Q

The symptom criteria (3) for female orgasmic disorder are…

A
  • Delayed, infrequent , diminished, or absent orgasm response
  • Distress or interpersonal problems 2/2 orgasmic dysfunction
  • Absence of disorder or substance
21
Q

The criteria to diagnose substance/medication-induced sexual disorder include: (3)

A
  • 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
22
Q

The top 2 medication classes that result in sexual dysfunction are…

A
  • SSRIs (up to 70%)
  • TCAs

NO SNRIs!!!

too much serotonin = inhibitory i think

23
Q

What kind of antipsychiatrics are NOT associated with sexual dysfunction?

A

Dopaminergics or selective serotonergics

Mirtazapine, bupropion, venlafaxine, duloxetine

Also buspirone

24
Q

Anticholinergics can reduce this part of the sexual response…

A

Arousal and lubrication

because they inhibit your secretions

25
Q

Which antiHTNs can cause sexual dysfunction?

A
  • BBs
  • Clonidine
  • Methyldopa
26
Q

Which substances can impair sexual function?

A
  • Nicotine
  • Alcohol
  • Opiates

Marijuana does not affect function!!!! only sperm

27
Q

What 3 organ systems, if dysfunctional, can affect sexual function as well?

A
  • Endocrine
  • Vascular
  • Neurologic

Also urinary too i guess

28
Q

Generally, are hormone tests good for evaluating sexual dysfunction?

A

Eh, usually NOT helpful

29
Q

First-line tx for menopausal vulvovaginal atrophy

A

Estrogen

You would give it if sexual dysfunction is 2/2 menopausal symptoms

30
Q

What is the consensus on using androgens for sexual dysfunction?

A

Not generally recommended

You also need lower dosages than a male patient would take.

31
Q

In premenopausal women, the FDA approved tx for low sexual desire/libido is….

A

Flibanserin/Addyi

body-ody-ody-ody (megan thee stallion)

32
Q

The MOA of flibanserin/addyi is…

A

5HT-1a agonist/5HT-2a antagonist

1 a in agonist, 2 as in antagonist

100mg tablet QHS

33
Q

The SEs of flibanserin/addyi include hypotension, dizziness, and fainting, which are exacerbated if a patient takes…

A

Alcohol

34
Q

Why is bupropion used off-label for sexual dysfunction?

A

Its MOA is to inhibit the reuptake of NE and dopamine, which are both excitatory hormones

35
Q

Two disorders are absolutely contraindicated with bupropion usage, which are…

A
  • Seizure disorder
  • Eating disorder
36
Q

PDE5 inhibitors, specifically sildenafil, are useful in women suffering specifically from…

A

SSRI-induced sexual dysfunction

Also neuro disorders

37
Q

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

A

No alcohol exacerbation in bremelanotide/vyleesi

38
Q

What is the MOA of Bremelanotide/Vyleesi?

A

Melanocortin receptor agonist in the brain

39
Q

How is bremelanotide/vyleesi dosed?

A

SC injection 45m before sexual activity

PRN dosing, better in older pts

40
Q

Non-pharm tx of female orgasmic disorder include: (3)

A
  • Sexual devices
  • Directed masturbation
  • Genital cosmetic procedures
41
Q

What is the LAST resort tx for GU syndrome of menopause due to cost and limited efficacy?

A

Vaginal laser/radiofrequency

42
Q

After conservative tx like pharm or cream for GU syndrome of menopause, you should recommend a patient to…

A

Pelvic floor PT

43
Q

The mainstay of tx for vaginismus is…

A

PT + tx underlying psych issue

44
Q

The initial approach to tx of vulvodynia is…

A
  • Removal of irritating agent
  • Promotion of good vulvar hygiene

ORAL MEDS ARE NOT FIRST LINE