discussing female sexual function and dysfunction, suggesting management and treatment

1. Female Sexual DysfunctionFemale Sexual Dysfunction
UPDATEUPDATE
Dr. Mamdouh SabryDr. Mamdouh Sabry
MD. Ain Shams, Ph.D Paris V Un. FranceMD. Ain Shams, Ph.D Paris V Un. France
Consultant Ob. & Gyn.Consultant Ob. & Gyn.
EL Mataria Teaching Hospital, Nasser InstituteEL Mataria Teaching Hospital, Nasser Institute
Cairo, EgyptCairo, Egypt

2. • Female sexual problems are common, and with
underestimated prevalence . 40% worldwide ??
• Female sexual dysfunction (FSD) was recently
redefined, now includes Female Sexual Interest/
Arousal Disorder (FSIAD), Female Orgasmic
Disorder and Genitopelvic Pain/ Penetration
Disorder. Either primary or secondary.
• These symptoms must cause distress and must
occur at least 75% of the time over a 6-month
period. This definition has been in place since the
development of the Diagnostic and Statistical
Manual, Fifth Edition (DSM-5) in 2013, so incidence
and prevalence based on the new definitions are
developing

3. Female Sexual Response Cycle
• Desire (libido)- including thoughts, wishes…
• Arousal (excitement)- sexual sense, genital
vasocongestion, heart and respiratory rate…
• Orgasm- peaking sexual pleasure……
• Resolution-relaxation and sense of well-being.
- The phases may vary in sequence, overlap,
repeat, or even be absent totally or partially.
- Females are motivated by emotional, psych.,
or other reasons, and sexual act may not lead
to orgasm or other response phases.

4. Pathophysiology
• Causes of FSD are diverse and overlapping..
Etiologies include hormonal, neurological and
vascular issues, as well as psychosocial factors as
relationship issues, social stress, mood, history of
physical or sexual abuse, and psychiatric history.
• Neurotransmitters play an important role, female
sexual function requires a delicate balance of
dopamine for desire, and epinephrine,
norepinephrine, and serotonin for arousal and
orgasm. Disorders and medications that disrupt
these elements may lead to FSD. Hormonal deficits
may be another factor in pathophysiology.

5. Estrogen And Androgens
• Decrease estrogen results in reduction of vulvo-
vaginal lubrication and vasocongestion during
arousal as well as vaginal atrophy and sexual pain.
• Decrease levels of estrogen were associated with
decrease libido and sexual responsiveness.
• Androgens are the same in women as men and
differ only in concentration.
• Conflicting data support its value in female sexual
act, but it is valuable…

6. Presentation
• Female Sexual Desire / Arousal
Disorder:
-Decrease sexual desire ( hypoactive )
-Sexual aversion disorder.
• Female Sexual Pain/ Penetrative
Disorder:
-Insertional, external or vaginal structures, or
deep, which would suggest intra-peritoneal
structures as a source.
• Female Orgasmic Disorder:

7. Diagnostic Consideration
• Sexual problems often overlap, with one problem
contributing to another. A woman with inadequate
arousal may experience insertional pain due to a
lack of lubrication. While patients may have multiple
sexual complaints, it is helpful to take a good history
that identifies which problem came first.
• Most FSD diagnoses are made based mainly on
history , and laboratory evaluation is rarely
helpful. Hypothyroidism affects desire.
• It is important to differentiate between a true disorder
and the normal changes over time.
• Orgasmic Disorder requires careful evaluation.

8. TREATMENT

9. Female Sexual Interest/ A. D.
• Many drugs have been implicated in impacting sexual
desire and arousal (as antihistamines, beta blockers,
diuretics and hormonal contraceptives), the
commonest are SSRI antidepressants
56%. Bupropion or mirtazapine are preferred.
• Flibanserin is a 5HT1A/2B agonist/ antagonist, FDA
approved, indicated for premenopausal women with
low sexual desire. It is taken nightly and requires
daily use.
• Androgens not approved in the US for sexual
dysfunction. However, multiple trials demonstrated a
positive effect of testosterone in postmenopausal
patients complaining of decreased libido,.

10. Orgasmic Disorder
• Lifelong or acquired, generalized or
situational !!!.
• Sildenafil 50 mg one hour before coitus.
• Stop SSRI.
• Exercise.
• Surgery.

11. Sexual Pain
• It is vulvo-vaginal or pelvic pain that is provoked by
or exacerbated during sexual contact.
• Pain can be mild to severe, generalized or
localized, lifelong or acquired, deep or superficial
and idiopathic or secondary.
• Endometriosis, genitourinary syndrome of
menopause, dermatoses as well as dyspareunia,
vulvodynia (persistent vulvar pain without an
identifiable etiology), and vaginismus (difficulty in
allowing vaginal penetration despite willingness to
do so) .

12. Sexual Pain cont.
• Treatment of the cause, deep or
superficial, hormonal or symptomatic,
Androgen or Estrogen.
• Vaginismus; local, surgical or Botox.
• Vulvodynia; Botox, PRP and local
anesthesia.
- Dilators are helpful, Reinjection is needed.

13. CONCLUSION

14. ●The diagnosis of female sexual dysfunction
is based upon the presence of diagnostic
criteria obtained through the medical and
sexual history.
● Estrogens and androgens are involved in ttt
but the magnitude of their roles needs further
clarification.
●Sexual function is strongly affected by
quality of relationship, sexual performance of
her partner and sociocultural factors.
●The effects of aging on female sexual
function vary considerably among women.

15. Thank you