Female&sexual& dysfunction&and& Interstitial&cystitis& Urology Grand Rounds November 14, 2012 Momoe Hyakutake, Urogynecology Fellow.

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1 Female&sexual& dysfunction&and& Interstitial&cystitis& Urology Grand Rounds November 14, 2012 Momoe Hyakutake, Urogynecology Fellow Objectives& 1) Overview of female sexual dysfunction 2) Explore the relationship between female sexual dysfunction and interstitial cystitis 3) Discuss treatment options 1&

2 Normal&sexual&response& 2&

3 DSM&IV>TR&criteria& Hypoactive&sexual&desire& disorder 1 & O Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. O The disturbance causes marked distress or interpersonal difficulty O The sexual dysfunction is not better accounted for by another Axis I disorder and is not due exclusively to the direct physiological effects of a substance or general medical condition 3&

4 Sexual&arousal&disorder 1 & O Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate lubrication-swelling response of sexual excitement O The disturbance must cause marked distress or interpersonal difficulty O The dysfunction is not better accounted for by another Axis I disorder Orgasmic&disorder 1 & O Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase O The disturbance must cause marked distress or interpersonal difficulty O The dysfunction is not better accounted for by another Axis I disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition 4&

5 Sexual&pain&disorders 1 & O Dyspareunia O Recurrent or persistent genital pain associated with sexual intercourse O Vaginismus O Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse Female&sexual&response&cycle 2 & 5&

6 6&

7 Available&evidence&suggests&that& there&are&problems&with&existing& definitions&of&sexual&desire,&arousal,& and&orgasmic&disorders&in&women 3 & Hypoactive sexual desire disorder Sexual desire / interest disorder 7&

8 Hypoactive&sexual&desire& disorder 1 & O Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. O The disturbance causes marked distress or interpersonal difficulty O The sexual dysfunction is not better accounted for by another Axis I disorder and is not due exclusively to the direct physiological effects of a substance or general medical condition Sexual&desire&/&interest& disorder 3 & O There is absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies, and a LACK OF RESPONSIVE DESIRE. O Motivations (reasons/incentives) for attempting to become sexually aroused are scarce or absent O Lack of interest is considered to be beyond the normative lessening with lifecycle and relationship duration 8&

9 Sexual&arousal&disorder 1 & O Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate lubrication-swelling response of sexual excitement O The disturbance must cause marked distress or interpersonal difficulty O The dysfunction is not better accounted for by another Axis I disorder Arousal& O Subjective arousal O Physiological arousal 9&

10 Arousal&disorder 3 & O Subjective arousal disorder O Genital sexual arousal disorder O Combined genital and subjective arousal disorder O Persistent genital arousal disorder 10&

11 Causes&of&female&sexual& dysfunction 3 & O Interpersonal and contextual factors O Personal psychological factors O Biological Sexual&dysfunction&and& Quality&of&life& 11&

12 Sexual&dysfunction&and& Quality&of&life 5 & O 137 patients with sexual dysfunction O General Health Questionnaire-28 O Personal Wellbeing Index-Adult O Measures quality of life in adults naeinian 12&

13 naeinian 13&

14 FSD&in&female&urology& patients 4 & O Female urology clinic O 587 women completed the modified female sexual function index O 63% of women had FSD elsamra et al. Elsamra et al &

15 15&

16 IC&and&FSD& O 1496 women met the criteria for BPS/IC O 985 women O Current partner O BPS / IC specific symptoms related to sexual intercourse O General sexual dysfunction Bladder pain during sex Bladder pain after sex Fear sex would exacerbate bladder problems Urge to urinate during sex BPS&/&IC&specific&symptoms& Not a problem Little of a problem Somewhat of a problem Very much a problem NA Pain in genital area Lack of sensation in genital area &

17 Lack of sexual interest General&symptoms& Not a problem Little of a problem Somewhat of a problem Very much a problem NA Cannot relax and enjoy sex Difficulty becoming sexually aroused Difficulty having orgasm Dryness/poor lubrication IC&and&FSD& O 88% reported 1 general sexual dysfunction symptom O 90% reported BPS/IC specific sexual dysfunction symptom O Only one quarter of the women reported seeking medical help for their sexual dysfunction symptoms 17&

18 IC&and&FSD& O BPS/IC specific sexual dysfunction was significantly associated with O More severe BSP/IC symptoms O Younger age O Worse depression symptoms O Worse perceived general health - 97 patients - 75 with newly diagnosed IC - 22 controls - Sexually active within the past month 18&

IC&and&Vulvodynia& Vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific clinically

19 IC&and&Vulvodynia& Vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific clinically identifiable neurologic disorder 8 60% of women with IC have vulvodynia +/- levator pain 9 ISSVD Terminology and Classification of Vulvar Pain (2003) peters 19&

20 Screening&& O Female sexual function index O 19 item questionnaire O Desire, subjective arousal, lubrication, orgasm, satisfaction, pain O Menopausal sexual interest questionnaire O 10 item questionnaire O Three domains (desire, responsiveness, satisfaction) Treatment& O Depends on the individual, current situation, well being, interpersonal relationship etc. 20&

21 Referral&& O BC centre for sexual medicine O O Multidisciplinary vulvodynia program O Take&home&points& O Female sexual dysfunction is highly prevalent among patients with interstitial cystitis O It is crucial to ask these patients about sexual dysfunction O Etiology is multifactorial O Treatment is highly individualized, multidisciplinary and multimodal O Refer! 21&

References& 1. Michael B First., ed. 2000. Diagnostic and Statistical Manual of Mental Disorders 4th Ed. (DSM-IV-TR, 2000). Washington, DC. American Psychiatric Association.

22 References& 1. Michael B First., ed Diagnostic and Statistical Manual of Mental Disorders 4th Ed. (DSM-IV-TR, 2000). Washington, DC. American Psychiatric Association. ISBN , ISBN STAT!Ref Online Electronic Medical Library 2. Basson R. Human sex-response cycles. J Sex Marital Ther. 2001;27(1): Basson R, Wierman ME, van Lankveld J, Brotto L. Summary of the recommendations on sexual dysfunctions in women. Journal of Sexual Medicine. 2010;7(1 Pt 2): Elsamra S, Nazmy M, Shin D, Fisch H, Sawczuk I, Fromer D, Female sexual dysfunction in urological patients:findings from a major metropolitan area in the USA BJU Int Aug; 106(4): Naeinian MR, Shaeiri MR, Hosseini FS, General Health and Quality of life in patients with sexual dysfunctions, Urol J, 2011;8: Bogart LM, Suttorp MJ, Elliott MN, Clemens JQ, Berry SH. Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis. Urology. 2011;77(3): Ottem DP, Carr LK, Perks AE, Lee P, Teichman JM. Interstitial cystitis and female sexual dysfunction. Urology. 2007;69(4): ISSVD terminology and classification of vulvodynia: a historical perspective.moyal- Barracco M, Lynch PJ. J Reprod Med Oct; 49(10): Peters K, Girdler B, Carrico D, Ibrahim I, Diokno A. Painful bladder syndrome/interstitial cystitis and vulvodynia: A clinical correlation. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5): Questions?& 22&

Female Sexuality Sheryl A. Kingsberg, Ph.D.

Female Sexuality Sheryl A. Kingsberg, Ph.D. Professor of Reproductive Biology Case Western Reserve University School of Medicine Chief, Division of Behavioral Medicine Department of OB/GYN University Hospitals