Female Sexual Dysfunction

Question 1

Sexual Response Cycle

Answer 1

spontaneous sexual drive: stimuli, aroual and seeking out/receptive to sexual stimuli
emotion and physical satifaction
arousal and sexual desire
emotional intamacy
biological psychological or socioculture factors

all have to be in place in order for proper seuxal response cycle to continue

• 40% of womn have disstressing sexual symptoms: 12% are conisdred “dysfuncions** therefore affectng QOL

three types
- female sexual interest/arousal disorder
- female orgasmic disorder
- gentio-peliv pain/penitration disorder MC

Question 2

Etiology and Pathophys of female sexual dysfunctions

Answer 2

Etiology
- multifactoral: bio, psycho, relational, socia-cultural factors
- all can lead to issues of pain, arousal, desire, orgasm, etc.

Chronic Disease: CAD, PVC, DM, GYN conditions, HTN, hypothyroid, Neuro, maignancy etc.
Aging
Hormones
Medications: statins, beta blockers & contraceptives, SSRis
Psychosocail: stress, depression, anxiext, trauma
culutre/religous

Question 3

General treatment principles of all sexual dysfunctions

Answer 3

Counceling
- couples therapy/sex thearpy
- lifestyle changes to reduce stress and fatigue
- improving body image

Question 4

Female Sexual Interest/Arousal Disorder
Etiology & Symptoms
Treatment

Answer 4

Etiology & Symptoms
- sexual desire = motivation to have sex
- sexaul arousal = physiological process of arousal: lubrication and warmth of vagina

arousal and desire often occur together

when treating
- important to discern if abscence is due to disorder or due to normal physiology (menopause!)

H&P: always look for organic, psycj, med causes

Treatment
- treat underlying cause/address psychosocial
- counceling

Medication Treatment
- androgen therapy (not FDA aprroved in females)
- Buproprion: if depression is underlying (avoid SNRI/SSRi because of decreases libido)
- bermalanotide: new and no data on it

Question 5

Female Orgasmic Disorder
Etiology
Treatmet

Answer 5

Etiology
- either markedly delayed orgasm or increased frequency of orgasm
- or inabiltiy to achieve orgasm

can be lifelong: like psychosocial or acquired: disease

H&P:loos for systemic or psychiatric causes

Treatmene = education
- directed masturbation/use of vibrators
- CBT

Question 6

Gentio-Pelvic Pain Penetration Disorder
Etiology and types of disorders

treatments for each

Answer 6

Genitourianry syndrome of menopause
- hyopestrogen vaginal atrophy
- treatment: lubricants or topical vaginal estrogen

provoked pelvic floor hypertonus
- usuall pain with deep penitration
- pelvic floor muslces tigheten on exam
- treatment: physiotherapy (biofeedback, dilaotrs, myofascial release)

Vaginismus
- uncontrollable muslce spasms with attened penitration
- usually underlying psych. issue
- treatment: CBT/thearpy, desensitizaiont and vaginal dilaotrs

Vulvar vestibulitis
- neuropathic related
- treatment: TCS or anticonvuslants

Question 7

SSRIs and Sexual Dysfunction

Answer 7

SSRIs impact sexual function
- decrease libido
- decreased arousal
- orgasms decreased

Options
- waiting for spontaneous remission (not effective)
- swap to non-SSRI or a different one paroxetine or escitalopram are the worst offenders
- use another med to offset: swap or add buproprion
- or a PDE-5 in men