SM_231b: Female Sexual Dysfunction Flashcards
Components of sexual response are ____, ____, ____, and ____
Components of sexual response are arousal, libido, intercourse, and orgasm
____ milieu is the major determinant of women’s sexual functioning
Neuroendocrine milieu is the major determinant of women’s sexual functioning
- Neurotransmitters: regulate excitatory and inhibitory neurochemicals which mediate sexual desire / arousal and orgasm / satisfaction
- Hormones: prime the brain to respond to neurotransmitters, prime genitals to respond to sexual stimuli to enhance arousal and orgasm
Describe central effects on sexual function
Central effects on sexual function
- Estrogen, testosterone, progesterone, and dopamine upregulate desire
- NE upregulates subjective excitement while prolactin downregulates
- Oxytocin upregulates orgasm
Describe peripheral effects on sexual function
Peripheral effects on sexual function
- Estrogen, testosterone, and progestin maintain genital structure and function
- 5-HT dowregulates sensation of clitoral and penile tissue. and vasocongestion
- NO, NE, prostaglandin E, and cholinergic fibers upregulate vasocongestion
___ is the desire to have sexual activity and sexual thoughts, images, and wishes
Libido is the desire to have sexual activity and sexual thoughts, images, and wishes
Serotonin, prolactin, and opioids ____ libido
Serotonin, prolactin, and opioids inhibit libido
Dopamine, melanocortin, estrogen, testosterone, and NE ____ libido
Dopamine, melanocortin, estrogen, testosterone, and NE excite libido
Limbic system is ____
Limbic system is excitatory
- Located at top of brainstem inferior to cortex
- Controls emotions, motivations, and pleasure
- Modulated by dopamine and NE
- Influences peripheral nervous system
- Includes hypothalamus (pituitary and hormonal regulation)
Pre-frontal cortex is ____
Pre-frontal cortex is inhibitory
- Regulates compulsive, reward seeking behavior
- Modulated by serotonin
- 5-HT
Describe hormones involved in libido
Hormones involved in libido
- Anterior pituitary secretes LH and FSH -> control production of androgens and estrogen
- Hormone receptors in hypothalamus
Correlation between androgen levels and sexual function is ___
Correlation between androgen levels and sexual function is weak to nonexistant
Describe regulation of libido
Libido
- Central regulation: yes
- Hormonal regulation: less but yes
- End organ physical regulation: no
Arousal is ____ accompanied by ____ such as ____
Arousal is a subjective sense of sexual pleasure accompanied by physiologic changes such as genital engorgement
Dopamine, NE, NO, ACh, estrogen, and androgens ___ arousal
Dopamine, NE, NO, ACh, estrogen, and androgens excite arousal
Serotonin and prolactin ___ arousal
Serotonin and prolactin inhibit arousal
____, ____, ____, and ____ lead to smooth muscle relaxation and genital blood flow during arousal
Neurotransmitters, endogenous stimulation, hormones, and intact vascular and nervous system lead to smooth muscle relaxation and genital blood flow during arousal
Describe genital manifestations of female arousal
Genital manifestations of female arousal
- Genital-clitoral engorgement
- Vaginal tenting (expansion of inner 2/3 of vagina)
- Perivaginal arterial dilatation
- Vaginal mucosal response (lubrication)
- Vagina is elongated by 3-4 cm during sexual arousal
Describe regulation of arousal
Arousal
- Central regulation: yes
- Hormonal regulation: yes
- End organ physical capability: yes
Intercourse requires ___ and ___
Intercourse requires pelvic floor muscles and vagina (lubrication, elasticity)
Requirements for a functional vaginal mucosa are ____, ____, and ____
Requirements for a functional vaginal mucosa are adequate blood supply, estrogen, and testosterone
- Lubrication primarily from transudate from vaginal wall mucosa secondary to vascular engorgement
Describe regulation of intercourse
Intercourse
- Central regulation: no
- Hormonal regulation: helps but not required
- End organ physical capability: yes
Orgasm is a ____ accompanied by ____, ____, and ____
Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by uterine contractions, anal contractions, and pelvic muscle contractions
- Resolves sexually induced vasocongestion and induces well-being and contentment
Describe oxytocin
Oxytocin
- Hormones originated from the paraventricular nucleus of the hypothalamus and secreted from the posterior pituitary
Secreted into the blood stream during arousal and orgasm - Considered to be a facilitator of arousal and orgasm
- Works synergistically with sex hormones to facilitate muscle contractions
Describe pathways of orgasm
Orgasm pathways
- Primary: clitoral stimulation -> spinal cord -> brain
- Alternate: vaginal / cervical stimulation -> vagus nerve / pelvic nerve
Describe orgasm during intercourse
10-30% of women are able to orgasm during penile-vaginal intercourse
____, ____, ____, and ____ are required to have an orgasm
Arousal, physical stimulation, adequate blood flow, and intact neurologic system are required to have an orgasm
Describe regulation of orgasm
Orgasm
- Central regulation: yes
- Hormonal regulation: no
- End organ physical regulation: yes
____, ____, and ____ are categories of female sexual dysfunction
Sexual desire / interest / arousal disorders, orgasmic disorders, and sexual pain are categories of female sexual dysfunction
- Not better accounted for by another primary psychiatric disorder or due exclusively to direct physiological effects of a substance
- Causes marked distress or interpersonal difficulty
- Affect 43% of all women and 60% of menopausal women
____, ____, ____, ____, ____, and ____ conditions can impact sexual function
Neurologic, endocrine, vascular, GU, systemic illness, and psychiatric conditions can impact sexual function
____, ____, and ____ are drugs commonly associated with female sexual dysfunction
Alcohol, OCPs, and SSRIs are drugs commonly associated with female sexual dysfunction
Hypoactive sexual desire disorder is ___
Hypoactive sexual desire disorder is persistent or recurrent deficiency or absence of sexual thoughts, fantasies and/or desire for or receptivity to sexual activity
- Causes marked personal distress or interpersonal difficulties
- Not better accounted for by another primary disorder, drug / medication, or general medical condition
Female orgasmic disorder is ____
Female orgasmic disorder is persistence of recurrent delay in or absence of orgasm after normal excitement phase which causes marked distress or interpersonal difficulty
- Anorgasmia: no orgasm
- Hypo-orgasmia: not much happening
- Delayed orgasm: takes too long to happen
- Persistent genital arousal syndrome: continuously happening
Primary anorgasmia is ___
Primary anorgasmia is never having the ability to reach orgasm
Secondary anorgasmia is ____
Secondary anorgasmia is inability to have an orgasm in a woman who was previously orgasmic
Describe risk factors for orgasmic disorders
Risk factors for orgasmic disorders
- Vascular disease: large vessel disease (atherosclerosis), small vessel disease (diabetes)
- Neurologic disease: neuropathies (diabetes), MS, SCI, surgical nerve damage
- Pelvic floor integrity (hypotonic pelvic floor, incontinence)
- Gynecologic conditions (lichen sclerosis, VVA)
____ are the most frequent cause of acquired orgasmic dysfunction
SSRIs are the most frequent cause of acquired orgasmic dysfunction
Dyspareunia is ____ and may be ____ or ____
Dyspareunia is pain during intercourse and may be superficial or deep
- May be caused by impaired vaginal lubrication
