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Female Sexual Interest / Arousal Disorder

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Female Sexual Interest / Arousal Disorder Female Sexual Interest / See SSRI sexual dysfunction Arousal Disorder decision support Asse ss for me dica tions w hich Refer to appropriate SSRI may affect sexual function History of physical/sexual/emotional abuse Present psychosocial services other (i.e SSRI, TCA, contraceptives, and/or intimate partner violence? and agencies available Benzodiazepines, antipsychotics) in community Reassess need for medication and transition if Substance use Appropriate Evaluate for partner Obtain full medical/sexual/ disorder? Present See corresponding Sexual dysfunction psychosocial history decision support Comorbid psychiatric Present disorder present? Treat underlyingPresent Evaluate for non-gynecological cause and reassess medical etiology Commorbidity absent Evaluate for gynecological etiology Symptom Is duration greater than 6 months Symptom persistence and causing significant distre ss? persistence Yes Female with Sexual Inte re st Arousa l Disorder Asse ss a nd e sta blish treatment expectations a nd goals Behavior Modification: Lifestyle changes Psychotherapy: Body image Sexual therapy Consider Sleep hygiene Trailored intervention Couples therapy combination therapy Stress reduction Based on H&P Mindfulness Pelvic therapy Relationship building Sexual novelty Inadequate response Continue Psychotherapy and Behavior modification interventions Inadequate response Consider topical oils (i.e. Zestra) in addition to Bupropion Pharmacotherapy Inadequate response Buspirone is less studied, however, it may be useful in some circumstances Postmenopausal? Buspirone No Yes Consider testosterone Flibanserin therapy. Consider consultation Inadequate response Bremelanotide FEMALE SEXUAL INTEREST /AROUSAL DISORDER Bupropion XL Antidepressant DOSING: starting dose 150mg XL qAM. Increase after 1 week to 300mg XL Wellbutrin XL (dopamine and qAM. Target dose 300mg- 450mg XL qAM. Max dose 450mg XL qAM. norepinephrine uptake inhibitor) SIDE EFFECTS: (common) insomnia, nausea, agitation, tremor (rare, serious) seizures, especially in patients with a history of seizures or eating disorders. Buspirone Anxiolytic (serotonin DOSING: starting dose 7.5mg BID or 5mg TID. Increase in 5mg/day increments BuSpar 5HT1A receptor every 2-3 days to target dose 15mg- 60mg total, divided BID to TID. partial agonist) SIDE EFFECTS: (common) dizziness, headache, nausea, jitteriness. (rare, serious) none reported. Testosterone Androgen DOSING: 300mcg/day transdermal patch applied 2x/week; requires Transdermal patch compounding pharmacy due to low dose. Benefits increase gradually over weeks to months. SIDE EFFECTS: (common) acne, breast pain, hirsutism, headache, weight gain (rare, serious) potential long term risks of breast cancer and heart disease, may warrant consultation with OB/Gyn or Endocrinology Zestra Botanical oil DOSING: apply to clitoris/ labia/ vagina before sex. over the counter Available at www.zestra.com or www.amazon.com SIDE EFFECTS: (common) mild genital burning sensation (14%) (rare, serious) none reported Flibanserin Mixed agonist-antagonist DOSING: 100mg qHS. Discontinue after 8 weeks if no improvement. Addyi postsynaptic serotonergic receptors SIDE EFFECTS: (common) dizziness, somnolence, nausea, fatigue (rare,serious) hypotension, syncope Black Box Warning- do not drink alcohol 2 hours before taking Flibanserin. Bremelanotide Melanocortin receptor DOSING: 1.75 mg subcutaneous injection PRN, 45 minutes before sex. Vyleesi agonist Do not use more than once in 24 hours or 8 times/ month SIDE EFFECTS: ((common) nausea (40%), flushing, injection site reactions, headache, vomiting (rare, serious) transient(up to 12 hour) increase in bp and decrease in heart rate after each dose, focal hyperpigmentation in 1% patients (may be permanent in half of these).
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