Women's Sexual Dysfunction

Question 1

What are the 3 types of women’s sexual dysfunction?

Answer 1

1. female orgasmic disorder
2. female sexual interest/arousal disorder
3. genito-pelvic pain/ penetration disorder

Question 2

How long do symptoms have to be present for diagnosis of Female orgasmic disorder?

Answer 2

6 months and not related to other physical, mental, or relational problems

Question 3

How long do symptoms have to be present for diagnosis of Female sexual interest/arousal disorder?

Answer 3

at least 6 moths of 3 of the following symptoms:
1. reduced interest in sexual activity
2. reduced sexual thoughts
3. reduced initiation/unresponsive to sexual activity
4. reduced pleasure in 75% of encounters
5. decreased response to internal/ external cues
6. reduced genital/ non-genital sensation at least 75% of the time

Question 4

Diagnosis of genito-pelvic pain/penetration requires what?

Answer 4

At least one of the following:
1. tightening of the vaginal muscles, prohibiting penetration
2. tension, pain, or burning sensation when penetration attempted
3. lack of desire to have intercourse
4. fear of penetration pain
5. avoidance of sexual activity

Question 5

What are nonpharm treatments for womens sexual dysfunction?

Answer 5

1. open communications
2. healthy lifestyle
3. counseling
4. lubricants
5. use of device

Question 6

How should local estrogen therapy be administered?

Answer 6

nightly x 2 weeks, then 2x/ week for maintenance

Question 7

What patients is local estrogen therapy used in?

Answer 7

1. specific symptoms of FSD in postmenopausal women
2. vaginal atrophy
3. can improve dyspareunia (painful intercourse)
4. improve sexual desire by increase lubrication and blood flow

Question 8

What role does testosterone have in FSD?

Answer 8

1. off-label for shot-term use
2. improves sexual desire in postmenopausal women

Question 9

What is the MOA of Ospemifine?

Answer 9

selective estrogen receptor modulator (SERM)

Question 10

What are indications for Ospemifine?

Answer 10

1. moderate-severe dyspareunia
2. vaginal dryness

Question 11

Ospemifine

Answer 11

OSPHENA

Question 12

What BBW does Ospemifine have?

Answer 12

risk of endometrial cancer and CV disease

Question 13

Flibanserin

Answer 13

ADDYI

Question 14

What is the MOA of Flibanserin?

Answer 14

1.mixed 5HT1A agonist/ 5HT2A antagonist
2. increase release of NE and DA and decrease 5HT in cortex
3. balance of NTs improve sexual functioning

Question 15

What is the indication for Flibanserin?

Answer 15

hypoactive sexual desire disorder in premenopausal women

Question 16

What BBWs does Flibanserin have?

Answer 16

1. hypotension
2. syncope

Question 17

What interactions should patients be counseled on with Flibanserin?

Answer 17

1. increased risk of hypotension with alcohol consumption
2. wait at least 2 hours after consuming 1 or 2 standard alcoholic drinks before taking at bedtime
3. SKIP dose if consumed 3+ drinks that evening

Question 18

What is Flibanserin CI with?

Answer 18

moderate/ strong CYP 3A4 inhibitors in patients with hepatic impairment

Question 19

Bremelanotide

Answer 19

VYLEESI

Question 20

What is the MOA of Bremelanotide?

Answer 20

melanocortin receptor agonist

Question 21

What is the indication for Bremelanotide?

Answer 21

hypoactive sexual desire disorder i premenopausal women

Question 22

What are CIs for Bremelanotide?

Answer 22

1, uncontrolled HTN (can increase 6mmHg/ 3mmHg)
2. CV disease

Question 23

What SEs does Bremelanotide have?

Answer 23

1. focal hyperpigmentation
2. nausea ~40%

Question 24

Prasterone

Answer 24

INTRAROSA

Question 25

What is the MOA of Prasterone?

Answer 25

synthetic steroid converted to active androgens and/or estrogens

Question 26

What is Preasterone indicated for?

Answer 26

dyspareunia after menopause

Question 27

What is a CI for Preasterone?

Answer 27

known/ suspected hx of breast cancer