Endocrine 2 Exam 2: Stewart-Lynch Women's Sexual Dysfunction

Female Sexual Dysfunction is sexual health concerns that cause:

personal distress, impact QOL, occurs in at least 1 area of sexual functioning

what are the 4 areas of sexual functioning?

desire, arousal, orgasm, pain

Female Sexual Dysfunction Contributing Factors (5):

partner, relationship, individual vulnerability, cultural, medical conditions

Female Sexual Dysfunction Contributing Factors:

examples of partner

health status, sexual dysfunction

Female Sexual Dysfunction Contributing Factors:

examples of relationship

communication, differences in desire

Female Sexual Dysfunction Contributing Factors:

examples of individual vulnerability

self-esteem, sexual or emotional trauma, stressors

Female Sexual Dysfunction Contributing Factors:

examples of cultural

stigma, perceptions

Female Sexual Dysfunction Contributing Factors:

examples of medical conditions (6)

CV disease, gynecologic cancers/genitourinary disorders, neurologic and psychiatric disorders, endocrine disorders

what is the name of the guidelines and when was it published?

International Consultation on Sexual Medicine, 2025

Hypoactive Sexual Desire Disorder (HSSD)

-defined as _____ or _____ desire to _____ in ____ ___ including ____ ____, ___ ____, and ___ _____

absent, reduced, engage, sexual activity, spontaneous desire, responsive desire, sustained desire

Hypoactive Sexual Desire Disorder (HSSD)

example of spontaneous desire

sexual thoughts/fantasies

Hypoactive Sexual Desire Disorder (HSSD)

example of responsive desire

arousal to stimulation/cues

Hypoactive Sexual Desire Disorder (HSSD)

example of sustained desire

after initiated

4 DSM-5 Classifications

female sexual interest/arousal disorder, female orgasmic disorder, genito-pelvic pain/penetration disorder, substance/medical-induced sexual dysfunction

DSM-5: Female Sexual Interest/Arousal Disorder

-complete lack/decrease in at least __ of the following for __ _____ (interest in sex, sexual thoughts, initiation of sexual activity/unreponsive to partner initiation, excitement or pleasure during sex, genital or nongenital sensations during sex)

3, ≥6 months

DSM-5: Female Orgasmic Disorder

-lack of ______ (ex. ______) or delayed/reduced frequency of orgasms persisting for __ ___

orgasm, anorgasmia, ≥6 months

DSM-5: Genito-Pelvic pain/penetration Disorder

-persistence or recurrence of at least __ of the following for at least __ ____(difficulty in vaginal intercourse, vulvovaginal/pelvic ____ during ___, ___ or ___ of vulvovaginal/pelvic pain during intercourse, pelvic floor _____ _____ during penetration, includes vaginismus and dyspareunia)

1, ≥6 months, pain, penetration, fear, anxiety, muscle tightening

DSM-5: Genito-Pelvic Pain/Penetration Disorder

-includes ___ (tensing of vaginal muscles) and ___

vaginismus, dyspareunia

dyspareunia =

painful intercourse

DSM-5: Substance/Medication Induced Sexual Dysfunction

-change in sexual function when ____, _____, or ___ a substance or medication

starting, changing, stopping

T/F Drug-Induced Sexual Dysfunction can happen in both men and women

True

When treating drug-induced sexual dysfunction, recognize that ____ are involved in ____ ____ of the _____ ____(desire, arousal, orgasm)

neurotransmitters, all phases, sexual response

____ _____ influences desire, arousal, and orgasm

serotonin negatively

what 2 drugs increase serotonergic activty?

SSRIs, TCAs

SSRIs and TCAs increase ____ activity, which negatively influences desire, arousal, and orgasm

serotonergic

If patient taking SSRIs/TCAs is experiencing drug-induced sexual dysfunction, often they should be switched to agents with more ____ and ___ activity

dopaminergic, noradrenergic

Clinicians often switch to agents with more dopaminergic and noradrenergic activity, such as ____, ____, and ____/___ (at higher doses)

bupropion, mirtazepine, venlafaxine/duloxetine

Counsel patient to avoid ___ and ____ (can also play a role in reducing desire, arousal, orgasm)

alcohol, marijuana

Mixed evidence on whether you should give ___ for drug-induced sexual dysfunction

COCs

Treatment for Sexual Dysfunction -

psychological interventions include:

cognitive behavioral therapy, mindfulness-based therapy, sex therapy

Treatment for Sexual Dysfunction - Non-pharm Interventions

2 types of interventions

dyspareunia, arousal/orgasm

Treatment for Sexual Dysfunction - Non-pharm Interventions

involves non-pharm intervention (if painful intercourse/dyspareunia, try ___ like __ ___ and ____ ____ like ____)

lubricants, KY Jelly, vaginal moisturizers, Replens

what do lubricants and vaginal moisturizers help with?

dysperunia

Treatment for Sexual Dysfunction involves non-pharm intervention

if issues with arousal/orgasm, try ___ ____ (___ and ___)

mechanical devices, OTC, Rx

What are 3 pharmacologic Interventions for Women's Sexual Dysfunction?

1. ___ (non-hormonal)

2. ___ (non-hormonal)

3. ___ (hormonal)

flibanserin, bremelanotide, systemic testosterone

What is the brand name of flibanserin?

Addyi

Flibanserin

-____ receptor ____/____

serotonin, agonist, antagonist

Flibanserin

-FDA approved in ___ and ___ menopausal women <___ years old for treatment of HSDD not due to another condition, medication, or relationship problem

pre, post, 65

Flibanserin

when is 100mg daily taken? If no improvement in this amount of time ______, then what do you do?

bedtime, 8 weeks, discontinue

Flibanserin

-Black Box Warning:

hypotension, syncope

Flibanserin

-if patient has had ___ or more alcoholic drinks-- _____ that evening dose!

3, skip

Flibanserin

-if patient has had 1-2 alcoholic drinks-- wait at least __ ___ after consuming ____ before taking med

2-4 hours, alcohol

Flibanserin

-DO NOT USE in ___ ____ or with moderate/strong ____ inhibitors (like _____ _____)

hepatic impariment, CYP3A4, grapefruit juice

Flibanserin

SEs include (6):

nausea, fatigue, dry mouth, angioedema/urticaria, CNS depression (somnolence/sedation)

Flibanserin

side effects could last __ ___ after each dose

6 hours

Flibanserin

-CNS depression, can worsened by taking other drugs with __ properties or ___

sedative, antihistamines

What is the brand name of bremelanotide?

Vyleesi

Bremelanotide

-________ receptor agonist

-FDA approved in ______ ____ for treatment of ___ not due to another condition, medication, or relationship problem

melanocortin, pre-menopausal women, HSDD

Bremelanotide

-dosing is 1.75mg ___ (into _____ or _____) at least __ ____ before ____ ____ activity

SQ, abdomen, thigh, 45 minutes, anticipated sexual

Bremelanotide

-max of __ ___ per ___; max ____ ____ per _____

-if no improvement at __ ___, ____ use

1 dose, day, 8 doses, month, 8 weeks, discontinue

Bremelanotide

why 8 doses per month?

prevent focal hyperpigmentation

Bremelanotide

-contraindicated in:

uncontrolled HTN, CV disease

Bremelanotide

-SEs include (5):

nausea, flushing, headache, BP/HR, focal hyperpigmentation

Bremelanotide

BP/HR increases for how many hours after each dose?

2-4 hours

Systemic Testosterone

-recommended ___ ___ for ___ ____ ___ for treatment of ____

off-label, post menopausal women, HSDD

Systemic Testosterone

-we do not use _____, ______, or ___ products for these patients bc these result in ___ than desired levels. ____agents also have _____ effects on ___ and ___ ____

IM, implant, oral, higher, desired levels, oral, negative, lipids, liver dysfunction

Systemic Testosterone

-we recommend ___ products

transdermal

Systemic Testosterone

-we recommend transdermal products at __/___ the ____ ____ ___ (ex. cream) applied to ___ __ ___or ___ ____ ____

1/10, male daily dose, back of calf, upper outer thigh

Systemic Testosterone

-after applying transdermal product, what must you do?

wash hands, wear covering to prevent transference

Systemic Testosterone

why must you check testosterone levels after initiated?

doses adjusted to achieve physiologic testosterone levels observed in pre-menopausal women

Systemic Testosterone

-effectiveness peaks at about __ ____

12 weeks

Systemic Testosterone

-If no improvement at ___ ___, ____ use

-If improvement, consider ____ __ after _-_ ___

-lack of safety data beyond ___ ____

6 months, discontinue, drug holiday, 6-12 months, 24 months

Systemic Testosterone

Not recommended in what population with history of, or at high risk for?

women breast/endometrial/ovarian, liver disease, hyperlipidemia

Systemic Testosterone

-SEs include (5):

acne, hirsutism, alopecia, clitoromegaly, voice deepening

Systemic Testosterone

-SE, voice deepening, is caused by?

dose dependent