SM_231b: Female Sexual Dysfunction

Question 1

Components of sexual response are ____, ____, ____, and ____

Answer 1

Components of sexual response are arousal, libido, intercourse, and orgasm

Question 2

____ milieu is the major determinant of women’s sexual functioning

Answer 2

Neuroendocrine milieu is the major determinant of women’s sexual functioning

• Neurotransmitters: regulate excitatory and inhibitory neurochemicals which mediate sexual desire / arousal and orgasm / satisfaction
• Hormones: prime the brain to respond to neurotransmitters, prime genitals to respond to sexual stimuli to enhance arousal and orgasm

Question 3

Describe central effects on sexual function

Answer 3

Central effects on sexual function

• Estrogen, testosterone, progesterone, and dopamine upregulate desire
• NE upregulates subjective excitement while prolactin downregulates
• Oxytocin upregulates orgasm

Question 4

Describe peripheral effects on sexual function

Answer 4

Peripheral effects on sexual function

• Estrogen, testosterone, and progestin maintain genital structure and function
• 5-HT dowregulates sensation of clitoral and penile tissue. and vasocongestion
• NO, NE, prostaglandin E, and cholinergic fibers upregulate vasocongestion

Question 5

___ is the desire to have sexual activity and sexual thoughts, images, and wishes

Answer 5

Libido is the desire to have sexual activity and sexual thoughts, images, and wishes

Question 6

Serotonin, prolactin, and opioids ____ libido

Answer 6

Serotonin, prolactin, and opioids inhibit libido

Question 7

Dopamine, melanocortin, estrogen, testosterone, and NE ____ libido

Answer 7

Dopamine, melanocortin, estrogen, testosterone, and NE excite libido

Question 8

Limbic system is ____

Answer 8

Limbic system is excitatory

• Located at top of brainstem inferior to cortex
• Controls emotions, motivations, and pleasure
• Modulated by dopamine and NE
• Influences peripheral nervous system
• Includes hypothalamus (pituitary and hormonal regulation)

Question 9

Pre-frontal cortex is ____

Answer 9

Pre-frontal cortex is inhibitory

• Regulates compulsive, reward seeking behavior
• Modulated by serotonin
• 5-HT

Question 10

Describe hormones involved in libido

Answer 10

Hormones involved in libido

• Anterior pituitary secretes LH and FSH -> control production of androgens and estrogen
• Hormone receptors in hypothalamus

Question 11

Correlation between androgen levels and sexual function is ___

Answer 11

Correlation between androgen levels and sexual function is weak to nonexistant

Question 12

Describe regulation of libido

Answer 12

Libido

• Central regulation: yes
• Hormonal regulation: less but yes
• End organ physical regulation: no

Question 13

Arousal is ____ accompanied by ____ such as ____

Answer 13

Arousal is a subjective sense of sexual pleasure accompanied by physiologic changes such as genital engorgement

Question 14

Dopamine, NE, NO, ACh, estrogen, and androgens ___ arousal

Answer 14

Dopamine, NE, NO, ACh, estrogen, and androgens excite arousal

Question 15

Serotonin and prolactin ___ arousal

Answer 15

Serotonin and prolactin inhibit arousal

Question 16

____, ____, ____, and ____ lead to smooth muscle relaxation and genital blood flow during arousal

Answer 16

Neurotransmitters, endogenous stimulation, hormones, and intact vascular and nervous system lead to smooth muscle relaxation and genital blood flow during arousal

Question 17

Describe genital manifestations of female arousal

Answer 17

Genital manifestations of female arousal

• Genital-clitoral engorgement
• Vaginal tenting (expansion of inner 2/3 of vagina)
• Perivaginal arterial dilatation
• Vaginal mucosal response (lubrication)
• Vagina is elongated by 3-4 cm during sexual arousal

Question 18

Describe regulation of arousal

Answer 18

Arousal

• Central regulation: yes
• Hormonal regulation: yes
• End organ physical capability: yes

Question 19

Intercourse requires ___ and ___

Answer 19

Intercourse requires pelvic floor muscles and vagina (lubrication, elasticity)

Question 20

Requirements for a functional vaginal mucosa are ____, ____, and ____

Answer 20

Requirements for a functional vaginal mucosa are adequate blood supply, estrogen, and testosterone

• Lubrication primarily from transudate from vaginal wall mucosa secondary to vascular engorgement

Question 21

Describe regulation of intercourse

Answer 21

Intercourse

• Central regulation: no
• Hormonal regulation: helps but not required
• End organ physical capability: yes

Question 22

Orgasm is a ____ accompanied by ____, ____, and ____

Answer 22

Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by uterine contractions, anal contractions, and pelvic muscle contractions

• Resolves sexually induced vasocongestion and induces well-being and contentment

Question 23

Describe oxytocin

Answer 23

Oxytocin

• Hormones originated from the paraventricular nucleus of the hypothalamus and secreted from the posterior pituitary
  Secreted into the blood stream during arousal and orgasm
• Considered to be a facilitator of arousal and orgasm
• Works synergistically with sex hormones to facilitate muscle contractions

Question 24

Describe pathways of orgasm

Answer 24

Orgasm pathways

• Primary: clitoral stimulation -> spinal cord -> brain
• Alternate: vaginal / cervical stimulation -> vagus nerve / pelvic nerve

Question 25

Describe orgasm during intercourse

Answer 25

10-30% of women are able to orgasm during penile-vaginal intercourse

Question 26

\_\_\_\_, \_\_\_\_, \_\_\_\_, and ____ are required to have an orgasm

Answer 26

Arousal, physical stimulation, adequate blood flow, and intact neurologic system are required to have an orgasm

Question 27

Describe regulation of orgasm

Answer 27

Orgasm * Central regulation: yes * Hormonal regulation: no * End organ physical regulation: yes

Question 28

\_\_\_\_, \_\_\_\_, and ____ are categories of female sexual dysfunction

Answer 28

Sexual desire / interest / arousal disorders, orgasmic disorders, and sexual pain are categories of female sexual dysfunction * Not better accounted for by another primary psychiatric disorder or due exclusively to direct physiological effects of a substance * Causes marked distress or interpersonal difficulty * Affect 43% of all women and 60% of menopausal women

Question 29

\_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, and ____ conditions can impact sexual function

Answer 29

Neurologic, endocrine, vascular, GU, systemic illness, and psychiatric conditions can impact sexual function

Question 30

\_\_\_\_, \_\_\_\_, and ____ are drugs commonly associated with female sexual dysfunction

Answer 30

Alcohol, OCPs, and SSRIs are drugs commonly associated with female sexual dysfunction

Question 31

Hypoactive sexual desire disorder is \_\_\_

Answer 31

Hypoactive sexual desire disorder is persistent or recurrent deficiency or absence of sexual thoughts, fantasies and/or desire for or receptivity to sexual activity * Causes marked personal distress or interpersonal difficulties * Not better accounted for by another primary disorder, drug / medication, or general medical condition

Question 32

Female orgasmic disorder is \_\_\_\_

Answer 32

Female orgasmic disorder is persistence of recurrent delay in or absence of orgasm after normal excitement phase which causes marked distress or interpersonal difficulty * Anorgasmia: no orgasm * Hypo-orgasmia: not much happening * Delayed orgasm: takes too long to happen * Persistent genital arousal syndrome: continuously happening

Question 33

Primary anorgasmia is \_\_\_

Answer 33

Primary anorgasmia is never having the ability to reach orgasm

Question 34

Secondary anorgasmia is \_\_\_\_

Answer 34

Secondary anorgasmia is inability to have an orgasm in a woman who was previously orgasmic

Question 35

Describe risk factors for orgasmic disorders

Answer 35

Risk factors for orgasmic disorders * Vascular disease: large vessel disease (atherosclerosis), small vessel disease (diabetes) * Neurologic disease: neuropathies (diabetes), MS, SCI, surgical nerve damage * Pelvic floor integrity (hypotonic pelvic floor, incontinence) * Gynecologic conditions (lichen sclerosis, VVA)

Question 36

\_\_\_\_ are the most frequent cause of acquired orgasmic dysfunction

Answer 36

SSRIs are the most frequent cause of acquired orgasmic dysfunction

Question 37

Dyspareunia is ____ and may be ____ or \_\_\_\_

Answer 37

Dyspareunia is pain during intercourse and may be superficial or deep * May be caused by impaired vaginal lubrication