3.5.2 Treatment of Female Reproductive Disorders

Question 1

What are the characteristics of premature puberty?

Answer 1

Puberty or thelarche before the age of 7 (causasian) or 6 (African American)

After age 6 or 7 if: Rapid progression of puberty. CNS findings or progression impacting emotional health of girl or family

Question 2

What are some genetic mutations that could cause premature ovarian failure?

Answer 2

Question 3

What are the characteristics of Hypergonadotropic Amenorrhea?

Answer 3

Elevated FSH

Premature ovarian failure

Question 4

Fill in this chart

Answer 4

Question 5

Is precocious puberty more common in girls or boys?

Answer 5

Girls

Question 6

How can hormonal therapy be used to treat sexual dysfunction?

Answer 6

Question 7

How would you treat a patient with central precocious puberty?

Answer 7

Use of depot GnRH agonist will result in regression or cessation of pubertal development

Early initiation will preserve growth

Many recommend cessation of treatment around age 11

Question 8

What is important about androgen therapy for HSDD?

Answer 8

Question 9

Describe the increase in sexual inactivity with age

Answer 9

Question 10

What Tanner stage corresponds with the onset of menses?

Answer 10

Tanner stage 3

Question 11

What are some treatment options for sexual pain disorders?

Answer 11

Pelvic floor physical therapy

Botox to overdevelop pelvic floor muscles

Dilator therapy

Lube

Question 12

What is primary amenorrhea?

Answer 12

No menses with or without the appearance of other features of puberty

Question 13

What is progressing precocoious puberty?

Answer 13

Progression between tanner stages w/in 3-6 months

Accelerated growth velocity

Advanced bone age

Falling off growth curve

Question 14

What are some possible etiologies of Sexual arounsal disorder?

Answer 14

Menopause, surg, diaabeeeetus, neurologic disease, psychological, vascular

Question 15

What is hypogonadotropic?

Answer 15

Hypothalamic (or pituitary) amenorrhea

Can be related to Anorexia, stress or exercise

Question 16

What are some possible CNS findings in a patient with a pubertal disorder?

Answer 16

Question 17

Fill in this chart

Answer 17

Question 18

What is Sexual Arousal Disorder (FSAD)?

Answer 18

Persistent or recurring inability to attain or maintain sufficient sexual excitement - decreased lubrication or labial sensation

Question 19

What is female sexual dysfunction?

Answer 19

The various ways in which an individual is unable to participate in a sexual relationship as she would wish

Question 20

What are some of the possible etiology of sexual pain disorders?

Answer 20

Question 21

How would you go about treating a patient with Sexual arousal disorder?

Answer 21

Sometimes a sex therapist needs to be consulted

Question 22

In an evaluation for a patient with a pubertal disorder what are some things you are looking at?

Answer 22

Question 23

What are the characteristics of puberty?

Answer 23

Puberty is the development of secondary sexual characteristics and menstruation in girls

Puberty requires the reactivation of the HPO axis and adrenal axis

Age of puberty has declined related to weight and nutrition

Question 24

Early age of adrenarche may be a sign of?

Answer 24

PCOS

Question 25

Describe the variability of the Menstrual cycle in adolescent females.

Answer 25

Question 26

Primary amenorrhea with significant adrenarche?

Answer 26

PCOS

Question 27

What occurs to initiate puberty?

Answer 27

GnRH regulates FSH and LH release - Pulsatility increases prior to puberty. Initially GnRH pulses occur during sleep FSH is first to appear LH pulsatility begins to mirror GnRH - maturation allows for the positive feedback by E2. Allowing the LH surge necessary for ovulation

Question 28

What is the average age of breast, pubic hair and menarche in puberty for US women?

Answer 28

Question 29

What is the prevalance of female sexual dysfunction?

Answer 29

43% of women

Question 30

What are some possibilities of problems that could cause peripheral precocious puberty?

Answer 30

Question 31

Describe androgen insufficiency in women

Answer 31

Question 32

What are some of the characteristics of the people and how they were affected according to the National Health and Social Life Survey?

Answer 32

Question 33

Describe the stages of reproductive aging?

Answer 33

Question 34

Describe the prevalence of Male and Female sexual complaints?

Answer 34

Question 35

Describe normal pubertal development in adolescent girls.

Answer 35

Question 36

What is hypoactive sexual desire disorder?

Answer 36

Persistent or recurring deficiency of sexual fantasies/thoughts and/ or receptivity to sexual activity Etiology - Menopause, aging, endocrine abnormality or Medications

Question 37

What is a good benefit for pelvic pain disorder?

Answer 37

Physical therapy

Question 38

How does testosterone relate to female sexual function?

Answer 38

Data from younger oophorectomized women support role of testosterone in sexual desire and orgasm.

Question 39

What are some sexual pain disorders?

Answer 39

Dyspareunia - recurrent or persistent genital pain associated with sexual intercourse Vaginismus - Recurrent or persistent involuntary spasms of the musculature of the outer third of the vagina that interferes with vaginal penetration

Question 40

What are the characteristics of primary amenorrhea?

Answer 40

Absence of menses by: Age of 13 in the ansence of any secondary sexual characterisitics Age 16 otherwise

Question 41

What are the 4 general categories of Female Sexual Dysfunction?

Answer 41

Libido Arousal Orgasm Sexual Pain

Question 42

What are the WHO classifications of Amenorrhea?

Answer 42

Question 43

What groups of people are at risk for androgen deprivation?

Answer 43

Premature ovarian failure Oophorectomy Hypopituitarism Addisons Corticosteroid Oral estrogen therapy

Question 44

What determines the age of menopause?

Answer 44

It is related to follicle deposition in ovary which is detemined prenatally

Question 45

What is androgen deprivation and what is important about it?

Answer 45

Androgen levels start to decline before age 30. At menopause - levels are half of that of a 30-40 year old. Abrupt change in androgen levels is not common with natural menopause but can be a prolen with surgical menopause