Sexual dysfunction Flashcards
patient with decreased sexual desire.
what is your ddx
female sexual interest and arousal disorder
medication or substances
relationship concerns
stress/anxiety
hx of female genital mutilation
genitourinary syndrome of menopause
SUI
premature ovarian failure
diabetes
sexual desire is triggers in what part of the brain?
via which neurotransmitter?
hypothalamus
dopamine
which neurotransmitters are released during orgasm
endogenous opioids, serotonin, prolactin, oxytocin
how long does one need to have symptoms of female sexual interest and arousal disorder to officially make the dx
6 months
which drug classes can cause female sexual interest and arousal disorder?
SSRI
antihypertensives
antihistamines
hormonal medications
MOA of flibanserin
serotonin receptor agonist/antagonist which results in decreased serotonin and increased norepinephrine and dopamine
Who can use flibanserin?
dosage
premenopausal women
100mg per day at bedtime
How many more sexually satisfying events can one expect on flibanserin?
increase of 0.4 to 1 sexually satisfying events per month from a baseline of 2-3 per month.
what are the alcohol limitations to flibanserin
no alcohol
if you hve 2 drinks, wait 2 hours
if you have 3 or more, then skip the dose
What is the typical pH of the postmenopausal vagina?
> 5.5
Estring dose
7.5 mcg/ 90 days
dose of vaginal insert (vagifem)
10 mcg 1 tab x 2 week
dose of premarin
0.625mcg per gram
0.5 gram 2-3 times per week
dose of estrace
100mcg pre gram
0.5 gram nightly for 1-2 weeks,
2-3 times per week
Can women with a hx breast cancer use DHEA?
evidence is not strong for safety, use estrogn. better data
