What percent of couples have some soft of sexual dissatisfaction/dysfunction?
50%
What are the three levels of arousal?
- Excitement
- Plateau
- Orgasm
What happens to the vagina with orgasm? Uterus?
- Contractions of perivaginal muscles and sphincter
- Uterine contractions
Is there any change with organsms post hysterectomy?
No
What are the different types of female sexual dysfunction?
- Sexual desire disorder
- Sexual arousal disorder
- Female orgasmic disorder
- Sexual pain disorder
What is sexual pain disorder?
Dyspareunia/vaginismus
What is the most common type of sexual disorder?
Desire disorder
Is testosterone therapy recommended for sexual desire disorder? Androgen?
No for either
Can vaginal dryness cause desire disorder?
True
What are the meds that can cause arousal disorders? (4)
SSRIs
EtOH
Antihypertensives
Anticholinergics
What is orgasmic dysfunction?
Inability to have an orgasm
What percent of women have never experienced an orgasm?
10-15%
What type of dyspareunia is experienced by women with endometriosis?
Deep
What are the causes of sexual pain disorders?
- Scarring
- Dryness
What percent of women have experienced sexual abuse?
1 in 5
What are the common emotional reactions to sexual abuse?
- fear
- Self blame
- depression/anxiety
What are the somatic complaints of sexually abused women?
HA
Insomnia
Choking
Hyperventilation
What is the best way to screen for sexual abuse?
Universal inquiry sheet
How do you counsel women who have had sexual abuse?
-Give pt control over disclosure
True or false: it is appropriate to postpone the pelvic exam if a woman is feeling uncomfortable (assuming no emergent need)
True
What are the three things that should be explained to patients before you do it?
- What will be done
- What it might feel like
- Why it is necessary
What is premenstrual syndrome?
Cyclical recurrence of symptoms during the luteal phase of menstruation
What are the somatic symptoms of PMS?
- Breast TTP
- Abdominal bloating
- HA
- Peripheral edema
When do PMS s/sx occur? When are they resolved?
- 5 days before menses
- Relieved within 4 days of the onset of menses
What is premenstrual dysphoric disorder?
Severe PMS, that interferes with function. Comparable to other mental disorders
What is the proposed cause of premenstrual dysphoric disorder?
Serotonergic dysregulation
What are the pharmacologic therapies for premenstrual dysphoric disorder?
SSRIs or hormonal ovulation suppression if severe
What are the two general types of s/sx of PMS?
Affective
Somatic
PMS can be diagnosed if the patient reports s/sx how many days before menstruation? They have to be relieved within how many days? How many menstrual cycles are needed?
- 5 days prior
- Relieved within 4 days of the onset of menses
- 3 menstrual cycles