Female Sexual Disorders - Exam 3

Question 1

What are the 4 stages of sexual response?

Answer 1

stage 1: Desire (Libido): intent to be sexually intimate

stage 2: Arousal: Lubrication and swelling (vascular congestion) of genital tissue

stage 3: Orgasm: Release of sexual tension,
Rhythmic contractions of reproductive organs, pelvic floor

stage 4: Resolution: Detumescence of genitalia. Subjective sense of satisfaction

Question 2

What is the modified cycle of female sexual response?

Answer 2

Question 3

What hormones have an excitatory effect on the female response?

Answer 3

estrogen
testosterone
dopamine
norepinephrine
oxytocin
melanocortins

Question 4

What hormones have an inhibitory effect on the female sexual response?

Answer 4

serotonin: at higher levels

prolactin: think nursing mothers and hyperprolactinemia

opioids

endocannabinoids

Question 5

What is the average age of puberty in females?

Answer 5

8-13 years old

Question 6

What are the different options for female sexual disorders?

Answer 6

low sexual desire

low arousal response

orgasm difficulties

sex related personal distress

sexual pain disorders

Question 7

What are some psychosocial issues that cause female sexual dysfunction?

Answer 7

Question 8

What is the MC type of female sexual disorders? What does it encompass?

Answer 8

Female Sexual Interest/Arousal Disorder

Encompasses problems with either low sexual desire or abnormal arousal response

Question 9

What is the criteria to qualify for a female sexual interest/arousal disorder?

Answer 9

Encompasses problems with either low sexual desire or abnormal arousal response (emotional/mental or lubrication/swelling)

Must occur 75% of the time or greater

Must have been occurring for 6+ months

Must cause distress for the patient

Question 10

What is considered genitopelvic pain/penetration disorder? What is a common historical finding?

Answer 10

Encompasses problems with either vaginismus, vulvar pain/vestibulodynia, or dyspareunia

same time constraints: 75% of the time, 6+ months, distress for the pt

History of sexual or physical trauma or abuse is common!

Question 11

What is vaginismus? What is dyspareunia?

Answer 11

vaginismus: involuntary vaginal
spasm

dyspareunia: pain with
penetration or sexual activity

Question 12

What is female orgasmic disorder? What are factors that contribute?

Answer 12

Encompasses problems with frequency, intensity, or achievement
of orgasm response

same time constraints: 75% of the time, 6+ months, cause distress

1. Psychiatric and social contributing factors
2. Patient position, arousal, and adequate stimulation
3. Medical conditions, including menopause

Question 13

What are common causes of substance/medication induced sexual disorder?

Answer 13

May affect desire, arousal, orgasm, or any other parameter of normal sexual function due:

to medication INCREASE

type of medication

Disturbance occurred during or soon after exposure to a medication, or substance intoxication/withdrawal

Absence of other symptoms/signs that would better explain the dysfunction

Question 14

What are the major medication culprits that lead to substance/medication-induced sexual disorder?

Answer 14

SSRIs: each SSRI is different for one pt so try another one!

TCAs

Anxiolytics

Anticonvulsants

Lithium or Barbiturates

anticholinergics: can reduce genital arousal and lubrication (antihistamines and antispasmodics)

antihypertensives: BBs, clonidine, methyldopa

hormonal agents: GnRH agonists/antagonists, SERMs, aromatase inhibitors

Question 15

What psych meds are a better options for less sexual dysfunction? ** Which one does Jensen likes?

Answer 15

Dopaminergic or selective serotonergic (mirtazapine, bupropion, venlafaxine, duloxetine) - not as associated with sexual dysfunction

Jensen likes bupropion

Question 16

What are substances that are commonly abused that can lead to sexual disorder?

Answer 16

nicotine: limits sexual arousal
alcohol
opiates
marijuana

Question 17

What type of state does alcohol and opiates put you in?

Answer 17

hypogonadotropic state; impaired overall function

Question 18

What organ symptoms that may be associated with a medical diagnosis known to cause female sexual disorders?

Answer 18

medical diagnosis known to affect:

endocrine
vascular
neurologic function: anticonvulsant drugs
urinary

May be a complaint of sexual-related distress that doesn’t fit other criteria

Question 19

What are the gynecologic conditions that can lead to female sexual disorders?

Answer 19

pregnancy and postpartum

infertility

endometriosis

uterine fibroids

pelvic organ prolapse

incontinence

GU syndrome of menopause

Question 20

What 3 aspects of a pt’s medical history can lead to sexual dysfunction?

Answer 20

chronic dz

medications

substance use

Question 21

What 2 labs should you order when evaluating for female sexual disorder? What is NOT helpful?

Answer 21

CBC-> anemia

STI screening

hormone levels are NOT helpful

Question 22

What are some general interventions that should be used in the treatment of sexual disorders?

Answer 22

counseling

lifestyle changes: Relieving stress/fatigue
Renewed emotional intimacy

Improving body image

pelvic floor dysfunction

usually requires complex, multifactorial cases with a trial of different treatments to find what is right for your pt

Question 23

______ is the most helpful for patients with menopausal VVA. What can it help with? What type of disorder is it NOT helpful with?

Answer 23

Estrogen

Can improve libido, arousal response, pain secondary to vaginal atrophy and can improve clitoral sensitivity

female orgasm disorders

Question 24

What are the SE of estrogen?

Answer 24

liver disease, endometrial hyperplasia and cancer, VTE events

Question 25

**______ is NOT indicated for sexual dysfunction alone but may be helpful as adjunt

Answer 25

estrogen

Question 26

_______ are generally NOT recommended for sexual disorders but when used, how are they dosed?

Answer 26

androgens (testosterone) dosed MUCH lower than in male pt ranges

Question 27

**_______ is approved for PREMENOPAUSAL patients who have low sexual desire. What is the MOA? How is it dosed?

Answer 27

Flibanserin (Addyi) 5HT-1a agonist / 5HT-2a antagonist: Causes transient decrease in 5HT and increase in norepinephrine/dopamine in certain regions of the brain aka pushed down serotonin and increases dopamine in certain areas of the brain have to take it everyday!

Question 28

What are the SEs of Flibanserin (Addyi)? What is the highlighted one? **What makes the SEs worse?

Answer 28

hypotension, dizziness, fainting hypotension **SE worse with alcohol

Question 29

______ is commonly used off-label for sexual dysfunction. What is the MOA?

Answer 29

Bupropion (Wellbutrin, Zyban) Norepinephrine and dopamine reuptake inhibitor

Question 30

**What are the CI to Bupropion? When should you dose it?

Answer 30

**seizure disorder, anorexia/bulimia, hypersensitivity to rx, use of MAOI in last 14 days possible risk of suicide in patients 18-24 years old dose in the AM due to insomnia

Question 31

What additional medications can be used in sexual dysfunction? What are the CAM options?

Answer 31

bupropion flibanserin CAM: Maca root, ginkgo biloba and saffron

Question 32

When are PDE inhibitors beneficial in sexual disorders? What disorders?

Answer 32

primary benefit seen in women with SSRI-induced sexual dysfunction (off-label use) slightly helpful in sexual function and orgasm but NOT helpful for desire causes

Question 33

What is the general overview taken from lecture of how useful PDE inhibitors are in treating sexual dysfunction?

Answer 33

aka only those who need help with increased blood flow do these work for in WOMEN

Question 34

______ approved for premenopausal patients with low sexual desire/libido. What drug class?

Answer 34

Bremelanotide (Vyleesi) Melanocortin Receptor Agonists

Question 35

Does Bremelanotide (Vyleesi) interact with alcohol? How is it dosed?

Answer 35

does NOT interact with alcohol SC injection 45 minutes before activity and dosed PRN

Question 36

What are some non-medication options for female orgasmic disorder?

Answer 36

Sexual Devices/Products Directed Masturbation Genital Cosmetic Procedures-> risk of tissue damage

Question 37

What are the tx options for GU syndrome of menopause?

Answer 37

vaginal estrogen therapy lubricants vaginal DHEA or testosterone oral ospemifene vaginal laser/RFA pelvic floor PT

Question 38

What is the tx for vaginismus?

Answer 38

Physical therapy in addition to treating any underlying psychological cause is the mainstay of treatment pelvic PT Rx: gabapentin, TCAs, cyclobenzaprine, botox

Question 39

What is the tx for vulvodynia?

Answer 39

Removal of irritating agent and promotion of good vulvar hygiene is the initial approach to improvement pelvic PT topical therapies