V In the name of god Female Sexual

V In the name of god

�Female Sexual dysfunction � �S. Vahidi (MD)

Female Sexual dysfunction � Introduction � Change in our Definition & understanding � High prevalence � New area for urologists. � Multiple theories , little evidence-based Medicine Documentation in Diagnosis & management

Classification ( Basson et al, 2004 b) � Women’s sexual interest /desire Disorder � � � � subjective sexual Arousal disorder Genital sexual Arousal disorder combined Genital & subjective sexual Arousal disorder persistent sexual Arousol disorder Women’s orgasmic disorder Dyspareuina Vaginismus Sexual Aversion Disorders.

Diagnosis 1 -History 2 - Physical Examination 3 -laboratory testing 4 - Specialized testing

� History 1 - sexual H. Diagnosis 2 -Medical H. 3 -symptoms of Estrogen-Androgen Deficiency 4 -Psychosocial H.

Diagnosis � Physical Examination v Confirm Normal Architecture , detect any pathology or abnormality, educate patient , localization the pain v Tailored to sexual Medicine complaint obtained on History taking v Allowing the patient and partner to observe the pathology v Examining room (Personal – Equipment ). v Peripheral genital exam. v General physical exam.

Diagnosis laboratory testing v Vaginal p. H ( 3. 5 -4. 5 ) v Wet mount testing ( background flora , vaginal EP. Cell, pathogens, WBC) v Blood testing Specialized testing v Vascular testing v Neurologic testing

Hormonal Therapy Premenopausal Women Estrogen and progesterone Irregular , abnormal Mens cycles DHEA: Vaginal lubrication – Vascular smooth M. Relaxation Acne – Hirsutism Testosterone : one day May prove that testosteron is efficient in Sexul prolems � Peri&post Menopausal Women( 30% of lives ) Estrogen : Improve vaginal lubrication , vaginal dryness and dyspareunia Androgenes : Improve: frequency of sexual Activity , pleasure and orgasm.

Nonhormonal Medical therapy - Dopamine Agonist Administration Apomorphine : Improved : orgasm , enjoyment and satisfaction Bupropion : Increase desire and frequency of sexual Activity. -Selective phosphodiesterase type 5 Inhitors : Normal Hormonal Milieu No hypoactive sexual desire Antidote to psychotropic induced S. D.

Medical therapy for Genital sexual pain disorders phimosis / Balanitis : Estrogen – testosteron – Nistatin Preputicl infection : Antibiotic– soaking – sitz bath traumatic Neuropathy : Psychotropic agents ( Amitriptyline ) Estrogen ( topical – systemic ) skene’s Gland Adenitis : estrogen? urethral prolopse : Estrogen ( topical – systemic ) Urethritis – Recurrent uti -I. C. Lichen sclerosis/ lichen planus : clobetasol

Medical therapy for Genital sexual pain disorders Vulvodinia : Amitriptylin and/or gabapentin Vulvar vestibulitis syndrom ( Most likely cause of dispareunia ) Ejucation-support– physical thrapy lidocaine Anti depressant Atrophic vajinitis : Estrogen Pelvic floor Disorders : ( High-tone, low-tone ) physiotherapy

Surgical Theropy for Genital- sexual pain disorders � � � � � Vestibulectomy Vestibuloplasty Vulvar Vestibulectomy Doral slit of the prepuce incision & drainage of Abccess excision of Fissure surgical excision of the prolapsed urethral Mucosa Marsupialization of cysts Redaction of labia Minora