Sexual Dysfunction Flashcards
1
Q
First line treatment dyspareunia?
A
Pelvic floor muscle training + cognitive behavioural + sexual therapy
2
Q
Topical treatment options dyspareunia? (7)
A
First line
- topical anaesthetic: lignocaine cream
- topical hormones for vaginal atrophy: oestrogen cream
Second line
- topical capsaicin cream: phenols produced by chili’s, initially burning + pain but later desensitisation of ion channels in sensory nociceptive neuron fibres.
- Vaginal prasterone: synthetic DHEA (dehydroepiandrostenedione)
Third line (no solid evidence)
- gabapentin cream
- amitriptyline topical preparations (combined with ketamine/ baclofen) : option if serious side effects from oral TCA
- cromolyn cream: mast cell stabiliser. Of use iF primary complaint pruritis
3
Q
Oral treatment options dyspareunia? (7)
A
First line
- ospemifine: SERM for dyspareunia associated with vulvar + vaginal atrophy.
Second line
- antidepressants: TCA, ssri, snri.
- neuropathic pain analgesia: antiepileptics gabapentin, pregabalin, carbamazepine
Third line
- Botox: block cholinergic innervation
Last resort
- injectable steroids
- vaginal laser therapy
- vestibulectomy
4
Q
Name 2 types and 4 broad causes dyspareunia
A
Superficial
- psychological (most common)
- vulvovaginal
→ vaginitis (atrophic, chemical, allergic, infectious)
→ vaginismus (involuntary tensing)
→ imperforate hymen
→ lichen sclerosis
→ inadequate lubrication
Deep
- Cervical
→ cervicitis
→ cervical cancer - Pelvic
→ endometriosis
→ adenomyosis
→ fibroids
→ ASO (strep A)
→ masses
→ ovarian cyst
5
Q
Name causes superficial dyspareunia (6)
A
- psychological (most common)
- vulvovaginal
→ vaginitis (atrophic, chemical, allergic, infectious)
→ vaginismus (involuntary tensing)
→ imperforate hymen
→ lichen sclerosis
→ inadequate lubrication
6
Q
Name 8 causes deep dyspareunia
A
- Cervical
→ cervicitis
→ cervical cancer
- Pelvic
→ endometriosis
→ adenomyosis
→ fibroids
→ ASO (strep A)
→ masses
→ ovarian cyst
