Pocket ObGyn – Female Sexual Dysfunction
See Abbreviations
Definitions (DSM-IV-TR)
- 4 major categories of disorders characterized by recurrence or persistence of sx: Sexual desires, arousal, orgasmic, sexual pain. Each must be accompanied by distress or interpersonal
- HSDD deficiency or lack of sexual thoughts, desire or Sexual aversion d/o is an aversive resp to genital contact w/ a sexual partner.
- Sexual arousal d/o is inability to achieve sexual excitement subjectively or
- Sexual orgasmic d/o: Difficulty achieving orgasm w/ suff sexual arousal
- Sexual pain d/o: Dyspareunia or vaginismus & noncoital pain
Epidemiology
- 43% prevalence: Low sexual desire (22–39%); arousal problems (14–26%); orgasm (21%), sexual pain (7%) (JAMA 1999;281:537; Obstet Gyn 2008;112, 976)
Etiology
- Organic or psychological or a mix of both; more than 1 dysfxn may Risks: ¯
age, ¯ educational attainment, ¯ social status, urinary tract sx, sexual trauma
- Medical (depression, anxiety, urinary incontinence, ESRD, anemia, thyroid, DM, substance or EtOH abuse, cancers), meds (SSRIs – most commonly, beta-blockers, antipsychotics), current relationship, sociocultural factors, estrogen deficiency, abn gyn etiology
Pathophysiology
- sexual resp cycle has 4 phases: Desire, plateau, orgasm, resolution as described by Masters & Johnson in Nonlinear model integrates emotional intimacy, sexual stimuli & relationship satisfaction; a sexual encounter may begin w/o desire initially present (Clin Update Women’s Health Care 2003;11(2):1).
Diagnostic Workup/Studies
- The Brief Sexual Symptom checklist, a screening questionnaire (J Sex Med 2010;337)
- Lab eval as clinically indicated: TSH, PRL, H&P for most eval.
Treatment and Medications
- Nonpharmacologic therapy (1st line): Identify rx goals, treat reversible causes; psychoanalysis, sex therapy w/ requisite exercises (dilators, vibrators) & Eros Therapy (FDA approved), pelvic floor physical therapy, desensitization, Kegel, & relaxation exercises
- Pharmacologic therapy: For HSSD, non-FDA approved rx w/ 300-mg testosterone patch 2´ weekly + ET for £6 mo; ET, a testosterone cream (0.5 g QD) topical (combined estrogen & testosterone therapy multi sexuality measures) (Menopause 2006;13:770).
- HRT for vasomotor & atrophy, low-dose vaginal postmenopausal ET for atrophy only; vaginal lubricants or moisturizers as an estrogen alternative; for dosing see on Menopause & therapy for urogenital atrophy.