Sexual dysfunction Flashcards

1
Q

patient with decreased sexual desire.

what is your ddx

A

female sexual interest and arousal disorder
relationship concerns
stress/anxiety
hx of female genital mutilation

2/2 other PFD: genitourinary syndrome of menopause, UI, POP

premature ovarian failure

medication or substances

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2
Q

sexual desire is triggered in what part of the brain?
via which neurotransmitter?

A

hypothalamus
dopamine

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3
Q

which neurotransmitters are released during orgasm

A

endogenous opioids, serotonin, prolactin, oxytocin

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4
Q

how long does one need to have symptoms of female sexual interest and arousal disorder to officially make the dx

A

6 months

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5
Q

which drug classes can cause female sexual interest and arousal disorder?

A

SSRI
antihypertensives
antihistamines
hormonal medications

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6
Q

MOA of flibanserin

A

serotonin receptor agonist/antagonist which results in decreased serotonin and increased norepinephrine and dopamine

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7
Q

SE of flibanserin

A

syncope, dizziness, hypotension

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8
Q

Who can use flibanserin?

dosage

A

premenopausal women

100mg per day at bedtime

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9
Q

How many more sexually satisfying events can one expect on flibanserin?

A

increase of 0.4 to 1 sexually satisfying events per month from a baseline of 2-3 per month.

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10
Q

what are the alcohol limitations to flibanserin

A

no alcohol
if you hve 2 drinks, wait 2 hours
if you have 3 or more, then skip the dose
CYP3A4

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11
Q

What is the typical pH of the postmenopausal vagina?

A

> 5.5

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12
Q

Estring dose

A

7.5 mcg/ 90 days

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13
Q

dose of vaginal insert (vagifem)

A

10 mcg 1 tab x 2 week

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14
Q

dose of premarin

A

0.625mcg per gram
0.5 gram 2-3 times per week

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15
Q

dose of estrace

A

100mcg pre gram
0.5 gram nightly for 1-2 weeks,
2-3 times per week

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16
Q

Can women with a hx breast cancer use DHEA?

A

evidence is not strong for safety, use estrogn. better data

17
Q

a post menopausal woman with dypsareunia due to genitourinary syndrome of menopause?

What can you give her?

A

prasterone or DHEA, vaginal insert 6.5 mg

Ospenmifine, oral

18
Q

Ospenmifine MOA

Dose

Does it increase risk of breast or endometrial cancer?

A

SERM- estrogen antagonist/agonist in the vagina

60 mg daily orally

no evidence to suggest increased breast or endometrial cancer

19
Q

SE of Ospenmifine

A

clots, hot flashes

20
Q

what is the evidence regarding fractional CO2 laser for vulvovaginal atrophy

A

only for use in research setting

21
Q

dyspareunia
whats your ddx?

22
Q

48 years old
low libido
ddx?

A

female sexual interest and arousal disorder
depression
stress
interpersonal relationship problems

23
Q

48 years old
low libido

History and physical exam?

A

smoking
prior BSO
menopausal sympotms-vaginal dryness, hot flashes
medications- SSRI, OCP, steroids,
stress level, exercise, relationship status, safety

visual inspection-atrophy
neuro exam looking for hypersensitivity, or asympetry in sensation
trigger points
masses
discharge, possible STI

24
Q

48 years old
low libido

she is on an SSRI. How would you counsel this patient?
what are alternative meds she could try

A

depression and SSRIs both can lead to low libido
consider switching meds
bupropioin and desvenlafaxine have lower risk of low libido

25
48 years old low libido natural ways to boost libido?
couples therapy date night, exercise lubricants stimulation toys stress management, improve sleep improving body image
26
48 years old low libido medicinal ways to improve this?
flibanserin (addyi) bremelanotide (vyleesi) prasterone off label bupropion or busparone
27
bremelanotide MOA SE?
melanocortin receptor agonist nausea, increased pigmentation at the injection site
28
cautions with bremelanotide?
FDA approved for premenopausal women not for High BP, naltrexone, or more than 8 times per month
29
your low libido patient wants Testosterone pellets. how do you counsel her?
1. not FDA approved for this indication in women 2. pellets can result in high doses bc we cannot control the bioavailability on a day to day basis 3. risks include hirsuitism, acne, virulization, cardiovascular problems, possible breast cancer due to aromatization of excess testosterone
30
what labs should be done before starting testosterone?
LFTs