Female Sexual Dysfunction 2

Question 1

What are the components of sexual desire?

Answer 1

• Biological: Drive
  
  • spontaneous sexual interest, relative but declines with age
• Cognitive: Expectations, beliefs, and values
  
  • is sex “acceptable”?
• Emotional: Motivation
  
  • interpersonal
  • willingness to engage, most important!

Question 2

What is the differential diagnosis for female sexual dysfunction?

Answer 2

• Hormonal endocrine dysfunction
  
  • estrogen
  • testosterone
• Vascular disease
  
  • atherosclerosis
  • trauma
  • hypoestrogenism
• Muscular disease
  
  • pelvic prolapse
  • vaginismus
• Neurologic disease
  
  • trauma
  • diabetes

Question 3

What are some common findings in female sexual interest/arousal disorder?

Answer 3

• Absent/decreased sexual interest
• Absent/decreased erotic thoughts or fantasies
• Absent/decreased activity in:
  
  • initiationof sexual activity or responsiveness to a partner’s attempts to initiate it
  • excitement and pleasure
  • response to sexual cues
  • sensations during sexual activity,
  • whether genital or non-genital

Question 4

What are medications that impact desire and arousal?

Answer 4

• Psychotropics
• Cardiovascular . Antihypertensives
• Hormonal medications
• Histamine blockers
• Antifungals
• Indomethacin
• Anticholinergics

Question 5

What are some cardinal features of sexual aversion disorder?

Answer 5

• Persistent/recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.
• Causes marked distress or interpersonal difficulty.
• Not better accounted for by another Axis I disorder (except another Sexual Dysfunction).

Question 6

What are some important features of orgasmic disorder, including the DSM definition?

Answer 6

• 5-15% of women never have an orgasm (anorgasmia)
• Usually the result of sexual inexperience, performance anxiety or past experiences that have led to inhibition of the sexual response
• Unlike men, in women, orgasm is a learned, not an automatic response
• Hormones not implicated
• DSM V definition:
  
  • absence, infrequency or delay of orgasm
  • reduced intensity of orgasm

Question 7

What is the treatment for orgasm disorder?

Answer 7

• Viagra (subjective vs objective arousal)
• Vibrator/Masturbation therapy
• Kegel Exercises
  
  • strengthen PC muscle, contract/relax 5 seconds, 10-15 times 3x/day…up to 200 repetitions per day)
  • greater ease in achieving orgasm, increased intensity of orgasm, increased lubrication, heightened control over sensation during penetration, and protection against urinary incontinence and bladder prolapse.
• EROS Therapy Device
• Sexual Therapy/Psychotherapy

Question 8

What is dyspareunia and vaginismus?

Answer 8

• Dyspareunia = Recurrent/persistent genital pain associated with sexual intercourse in either a male or a female.
• Vaginismus = Recurrent/persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
  
  • most common in pre-menopausal women
  • may be fear-based particularly with women who have a history of

Question 9

What are the DSM V criteria for gento-pelvic pain/penetration disorder?

Answer 9

• Inability to have vaginal intercourse/penetration
• Vulvovaginal or pelvic pain during vaginal intercourse/penetration attempts
• Fear or anxiety either about vulvovaginal or pelvic pain or vaginal penetration
• Tensing or tightening of the pelvic floor muscles during attempted vaginal penetration