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Repro / GU > SM_231b: Female Sexual Dysfunction > Flashcards

SM_231b: Female Sexual Dysfunction Flashcards

1
Q

Components of sexual response are ____, ____, ____, and ____

A

Components of sexual response are arousal, libido, intercourse, and orgasm

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2
Q

____ milieu is the major determinant of women’s sexual functioning

A

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
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3
Q

Describe central effects on sexual function

A

Central effects on sexual function

  • Estrogen, testosterone, progesterone, and dopamine upregulate desire
  • NE upregulates subjective excitement while prolactin downregulates
  • Oxytocin upregulates orgasm
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4
Q

Describe peripheral effects on sexual function

A

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
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5
Q

___ is the desire to have sexual activity and sexual thoughts, images, and wishes

A

Libido is the desire to have sexual activity and sexual thoughts, images, and wishes

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6
Q

Serotonin, prolactin, and opioids ____ libido

A

Serotonin, prolactin, and opioids inhibit libido

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7
Q

Dopamine, melanocortin, estrogen, testosterone, and NE ____ libido

A

Dopamine, melanocortin, estrogen, testosterone, and NE excite libido

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8
Q

Limbic system is ____

A

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)
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9
Q

Pre-frontal cortex is ____

A

Pre-frontal cortex is inhibitory

  • Regulates compulsive, reward seeking behavior
  • Modulated by serotonin
  • 5-HT
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10
Q

Describe hormones involved in libido

A

Hormones involved in libido

  • Anterior pituitary secretes LH and FSH -> control production of androgens and estrogen
  • Hormone receptors in hypothalamus
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11
Q

Correlation between androgen levels and sexual function is ___

A

Correlation between androgen levels and sexual function is weak to nonexistant

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12
Q

Describe regulation of libido

A

Libido

  • Central regulation: yes
  • Hormonal regulation: less but yes
  • End organ physical regulation: no
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13
Q

Arousal is ____ accompanied by ____ such as ____

A

Arousal is a subjective sense of sexual pleasure accompanied by physiologic changes such as genital engorgement

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14
Q

Dopamine, NE, NO, ACh, estrogen, and androgens ___ arousal

A

Dopamine, NE, NO, ACh, estrogen, and androgens excite arousal

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15
Q

Serotonin and prolactin ___ arousal

A

Serotonin and prolactin inhibit arousal

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16
Q

____, ____, ____, and ____ lead to smooth muscle relaxation and genital blood flow during arousal

A

Neurotransmitters, endogenous stimulation, hormones, and intact vascular and nervous system lead to smooth muscle relaxation and genital blood flow during arousal

17
Q

Describe genital manifestations of female arousal

A

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
18
Q

Describe regulation of arousal

A

Arousal

  • Central regulation: yes
  • Hormonal regulation: yes
  • End organ physical capability: yes
19
Q

Intercourse requires ___ and ___

A

Intercourse requires pelvic floor muscles and vagina (lubrication, elasticity)

20
Q

Requirements for a functional vaginal mucosa are ____, ____, and ____

A

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
21
Q

Describe regulation of intercourse

A

Intercourse

  • Central regulation: no
  • Hormonal regulation: helps but not required
  • End organ physical capability: yes
22
Q

Orgasm is a ____ accompanied by ____, ____, and ____

A

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
23
Q

Describe oxytocin

A

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
24
Q

Describe pathways of orgasm

A

Orgasm pathways

  • Primary: clitoral stimulation -> spinal cord -> brain
  • Alternate: vaginal / cervical stimulation -> vagus nerve / pelvic nerve
25
Q

Describe orgasm during intercourse

A

10-30% of women are able to orgasm during penile-vaginal intercourse

26
Q

____, ____, ____, and ____ are required to have an orgasm

A

Arousal, physical stimulation, adequate blood flow, and intact neurologic system are required to have an orgasm

27
Q

Describe regulation of orgasm

A

Orgasm

  • Central regulation: yes
  • Hormonal regulation: no
  • End organ physical regulation: yes
28
Q

____, ____, and ____ are categories of female sexual dysfunction

A

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
29
Q

____, ____, ____, ____, ____, and ____ conditions can impact sexual function

A

Neurologic, endocrine, vascular, GU, systemic illness, and psychiatric conditions can impact sexual function

30
Q

____, ____, and ____ are drugs commonly associated with female sexual dysfunction

A

Alcohol, OCPs, and SSRIs are drugs commonly associated with female sexual dysfunction

31
Q

Hypoactive sexual desire disorder is ___

A

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
32
Q

Female orgasmic disorder is ____

A

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
33
Q

Primary anorgasmia is ___

A

Primary anorgasmia is never having the ability to reach orgasm

34
Q

Secondary anorgasmia is ____

A

Secondary anorgasmia is inability to have an orgasm in a woman who was previously orgasmic

35
Q

Describe risk factors for orgasmic disorders

A

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)
36
Q

____ are the most frequent cause of acquired orgasmic dysfunction

A

SSRIs are the most frequent cause of acquired orgasmic dysfunction

37
Q

Dyspareunia is ____ and may be ____ or ____

A

Dyspareunia is pain during intercourse and may be superficial or deep

  • May be caused by impaired vaginal lubrication

Repro / GU (46 decks)

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