Mod 3.5 Female Sexual Dysfunction

Question 1

What are four general causes for Female sexual dysfunction?

Answer 1

1. Medical disease
   
   • Neurological disorders - ANS
     
     • increase Parasympathetic tone and decrease sympathetic tone is important for normal sexual response
2. Pharmacological tx
   
   • SSRI’s
3. Medical therapy/surgical procedures
   
   • Pelvic radiation
   • Hysterectomy
     
     • damage to autonomic nerves
4. Past/ongoing psychological factors

Question 2

What is dyspareunia?

Answer 2

Sexual pain

Question 3

What is vulvodynia?

Answer 3

Pain anywhere on the vulva (stops at hymen)

Question 4

What is vestibulodynia

Answer 4

Pain of the vestibule

Question 5

Pain involving the clitoral glans and hood is called

Answer 5

cloitorodynia

Question 6

Pain anywhere on the vulva:

Answer 6

Vulvodynia

Question 7

Pain of the vestibule:

Answer 7

Vestibulodynia

Question 8

What are treatment options for sexual pain in females? (7)

Answer 8

1. Clinical acknowledgement and diagnosis
2. Topical lidocaine
3. Estrogen creams (at vestibule)
4. Medication for nerve pain (migraine/fibromyalgia)
5. Pelvic floor therapy
6. Injection to produce nerve block
7. Surgery (partial removal of vestibule)

Question 9

What are five possible causes of sexual pain in females?

Answer 9

1. Reduced or absent vaginal lubrication
2. Infection of reproductive tract (impede vaginal expansion)
3. Clitoral damage or irritation
4. Displaced/prolapsed uterus
5. Sexual fears/inhibitions
   
   • anxiety increases sympathetic tone which decreases lubrication

Question 10

Persistent or recurrent difficulty to allow vaginal penetration despite the desire to do so:

Answer 10

Vaginismus

Question 11

What is vaginismus?

Answer 11

Persistent or recurrent difficulty to allow vaginal penetration despite the desire to do so

Question 12

What are symptoms of vaginismus?

Answer 12

Painful spasms/involuntary contractions of the outer third of the vaginal wall and surrounding muscles

Question 13

What are possible causes of vaginismus?

Answer 13

• Psychological states
  
  • Fear of coitus, pregnancy, frustration with partner
• Scar tissue in vagina or vulva
  
  • Childbirth; episiotomy, vaginal infection

Question 14

How might vaginismus be treated?

Answer 14

• Therapy
  
  • pain elimination techniques
  • address cognitive/emotional contributions
• Kegel exercises - improve pelvic floor muscles
• Progressive desensitization
  
  • insertion and dilation training

Question 15

What is the difference between primary and secondary orgasmic dysfunction?

Answer 15

• Primary:
  
  • pt has never had an orgasm
  • 1/5 women (20%)
• Secondary
  
  • Pt fails to reach orgasm in selective situations
    
    • with sufficient stimulation and high levels of excitement and arousal
  • 20% of females
  • 1/3 unable to reach orgasm vaginally
• Partly genetic

Question 16

How might orgasmic dysfunction because of low circulating estrogen be treated?

Answer 16

• Estrogen treatment is mostly ineffective however, androgen supplementation shows some improvement in libido and orgasm
  
  • difficult to tell if its the androgen itself or the conversion of androgen to estrogen in the brain
    *

Question 17

What are three treatments under investigation for orgasmic dysfuntion in females?

Answer 17

• Viagra
  
  • sildenafil
  • increases blood flow to clitoris
• Hormonal treatments
  
  • Estrogens
    
    • oral or topical
  • Androgens
    
    • Topical
• Clitoral suction device
  
  • increase blood flow and sensation

Question 18

Possible causes of orgasmic dysfunction?

Answer 18

• Psychological:
  
  • Central descending input can inhibit orgasm
• Physiological (rare)
  
  • Illness, fatigue, aging/menopause
    
    • Diabetes - 50% females report diminished capacity to reach orgasm
  • Absence of adequate circulating estrogne
    
    • vaginal dryness