Sexual Dysfunction Flashcards
Vaginal moisturizers
use 2-3x per weeks because they last 2-3 days
Replense - almost as effective as Estrace for vaginal dryness
Luvena - 2 enzymes: 1 anti-candida, 1 antibacterial
Hyalogen - attracts 60x its weight in water. Designed for Breast cancer survivors
Refresh - has a probiotic
Medications that can decrease sexual functioning
ANTIDEPRESSANTS/MOOD STABILIZERS
* Selective serotonin reuptake inhibitors (SSRIs) * Serotonin-norepinephrine reuptake inhibitors (SNRIs) * Tricyclics * Antipsychotics * Benzodiazepines * Antiepileptics * Monoamine oxidase inhibitors (MOAIs)
ANTIHYPERTENSIVES
* β-blockers * α-blockers * Diuretics
CARDIOVASCULAR AGENTS
* Lipid-lowering agents * Digoxin
HORMONES
* ** HORMONAL CONTRACEPTIVES! * Estrogens * Progestins * Antiandrogens * Gonadotropin-releasing hormone (GnRH) agonists
OTHER
* Histamine2-receptor blockers * Narcotics * Amphetamines * Anticonvulsants
Female Orgasmic Disorder
DSM V criteria
Presence of either of the following on all or almost all (75%- 100%) occasions of sexual activity:
1) Marked delay in, marked infrequency of, or absence of orgasm. 2) Markedly reduced intensity of orgasmic sensations
Symptoms persisted a minimum of 6 months and not better explained by a nonsexual mental disorder or consequence of severe relationship distress or other significant stressors and not due to effects of substance/medication or other medical condition
Female Sexual Interest/Arousal Disorder
DSM V criteria
Lack of, or significantly reduced, sexual interest/arousal as manifested by 3 of the following:
1) Absent/reduced interest in sexual activity 2) Absent/reduced sexual/erotic thoughts or fantasies 3) No/reduced initiation of sexual activity and unreceptive to partner’s attempts to initiate 4) Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (75%-100%) sexual encounters 5) Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (written, verbal, visual) 6) Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (75%-100%) sexual encounters
Symptoms persisted a minimum of 6 months and not better explained by a nonsexual mental disorder or consequence of severe relationship distress or other significant stressors and not due to effects of substance/medication or other medical condition
Genito-Pelvic Pain/Penetration Disorder
DSM V criteria
Persistent or recurrent difficulties with 1 or more of the following:
1) Vaginal penetration during intercourse 2) Marked vulvovaginal or pelvic pain during intercourse or penetration attempts 3) Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration 4) Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
Symptoms persisted a minimum of 6 months and not better explained by a nonsexual mental disorder or consequence of severe relationship distress or other significant stressors and not due to effects of substance/medication or other medical condition
What neurotransmitters increase sexual arousal and desire for sexual activity?
Norepinephrine and Dopamine
What neurotransmitter signals sexual satiety or inhibition
Seretonin
What neurotransmitters are involved in attachment/bonding and are prosexual?
Oxytocin and melanocortins
Chronic diseases that negatively affect sexual functioning
MOOD DISORDERS - major depression, bipolar disorder
ANXIETY DISORDERS - generalized anxiety, specific phobia
PSYCHOTIC DISORDERS - schizophrenia
ENDOCRINE DISORDERS - diabetes, thyroid disorders, hyperprolactinemia, adrenal insufficiency
UROLOGIC - renal failure, urinary incontinence, UTI
CARDIAC AND VASCULAR - hypertension, CAD, MI
GYNECOLOGIC - STIs, Chronic Pelvic Pain/Endometreosis, Dyspareunia/Vulvar Pain Disorders, Vulvovaginal Atrophy, Chronic Vulvovaginal Candidiasis, Postpartum Physical/Hormonal Changes, Pelvic Organ Prolapse
CANCER/SURGICAL/CHEMO - Breast Cancer, Anal Cancer, Colorectal, Gynecological
DERMATOLOGIC - Eczema, Psoriasis. Paget’s, Vulvar Dystrophies
Psychosocial factors that affect sexual function
Relationship conflict
Major life stressor(s)
Boredom
Discrepant desire levels between partners
Cultural/religious prohibitions/guilt
Subclinical depression/anxiety/body image
What is the PLISSIT acronym for office based counseling?
Permission to talk about sexual issues, reassurance and empathy
Limited Information
e.g., education about genital anatomy or educational resources
Specific Suggestions
e.g., use of lubricants, altering position
Intensive Therapy
e.g., referral for psychotherapy
Distinguish cognitive behavioral therapy from sex therapy
Cognitive-behavioral therapy
* Alters dysfunctional emotions, behaviors and cognitions through systematic procedure
Sex Therapy
* Brief (5-20 session) solution-focused treatment * Refocus patient/couple on motivation component of desire * Restructure perceptions of partner and lovemaking
What is the “sensate focus” in sex therapy?
Most well-known technique and most frequently prescribed behavioral sex therapy
Series of progressive, in vivo (homework) desensitization exercises
Enhance partners’ awareness of pleasurable experiences, preferences for sexual touch
Reduces anxiety
Name some FDA approved therapies for FSD
OSPHENA - SERM used for primary dyspareunia (agonist in vagina, endometrium, bone)
PREMARIN CREAM - conjugated estrogen. 0.5 gram BIW for post-menopausal dyspareunia
INTRAROSA - intravaginal DHEA.
* Precursor of estrogen and testosterone. Acted on by intracellular enzymes to convert to estrogen/testosterone * Talk to oncologist if cancer survivor * Daily for post-menopausal dyspareunia. FDA approved for post menopause only. Used off-label for premenopausal PVD
ADDYI (FLIBBANSERIN)
* approved for hypoactive sexual desire disorder (HSDD) * Transient decreases in serotonin/Increases levels of dopamine and norepinephrine → calm + increased desire * Taken q day * Black box warning: no alcohol → drop in BP * SE: mild nausea, dizziness, fatigue, somnolence * works in about 50% of people, d/c if no improvement in 8 weeks
Evidence based nutraceutical options for FSD
ARGINMAX: Oral L-Arginine (precursor to N.O), ginseng, gingko and damiana. Embedded in multivitamin, available at GNC.
STRONVIVO: L-arginine, L citraline, L carnitine, zinc, Magnesium. For arousal, orgasm, and pain
ZESTRA: Essential arousal oil: vasodilatory oil of angelica, coleus, evening primrose. Must massage into non-mucous membrane. Smells of Juicy Fruit
