4 T H COFFEE Aleece Fosnight, MSPAS, PA Women’s Sexual Women’s Urology, Women’s Health, Sexual Medicine Skin, Bones, Hearts and Private Parts 2021 Health Trivia - C, CSC - S, CSE, NCMP,IF 4 T H COFFEE • • Howwork?does this • Finalquestion There are two roundsof five questions Break into teams • • • • You will have 3minutes to answer question Bid on as many points as you want You will have 2minutes questionper to answer Bid on the points for each question – Come up with a teama with nameCome up 4 T H COFFEE Women’sSexual HealthTrivia ROUND ONE 4 T H COFFEE the CDC estimatesCDC the there that aremillionnewthatSTIs20 nearly two sexualityByinone age 25, active persons will contactSTI and an Question #1 D. C. B. A. following of the WhichSTI? mostcommonthe is UnitedStatesthe in occur every year. AnogenitalHerpes PapillomaHuman (HPV) Virus Gonorrhea Chlamydia 4 T H COFFEE • • • Answer: C • • 2014 Gardasil 9 valent vaccine We have identified over 150 strains of HPV If persistent 30,700 cases of cancer in men and women 9/10 infections will clear<2years 80 million people currently affected (1 in 4) and 14 million new each year • • • • • • • • • Immunizationbenefits Effectiveagainst 58 45,52, 18,31, 11,16, 3, 6, types: HPV Approved forat 3 doses 2,and6months 0, for F/M 15 ages Approved forat 2 doses and6 0 monthsfor F/M 9 ages Anal =HPV Oropharyngeal= HPV Vulvar cancerHPV = Cervical cancer= HPV Condyloma • Australia’snationalHPVVaccination Program: 29 - 16 and HPV 16 acuminatum – HPV! - 16,HPV - - 16 (60%) 16 16 and HPV16 - 18 (90%) 18 = HPV - 18, and HPV 18, - 6 and HPV6 - 18 (70%) 18 - 31 (50%) 31 - 11 (90%) 11 - 40% girls agegirls11 40% - 14 - 45 - 12 and 63 and 12 - 67% boys67% 4 T H COFFEE or not enough foreplay.enough or not way One to improvediscomfort during relatedtoeither vaginal dryness tomedications,medical conditions, reasonsencounterwomenmain the of dyspareuniasecondary One is Question #2 D. C. B. A. Whatpercentage have of women personala lubricant? used question sexualpenetration personaltoa is lubricant.use ***lubricant 88% 70% 57% 20% 4 T H COFFEE • Answer: C • • • Lubricantsafety the lubricantApply toentire the genital area pleasure Mostlubricantwomena use pleasureself during vs partnered sexualsatisfaction Lubricantshave tovaginalincreaseshownand aid in been dryness • • • • • AvoidKYJelly, Brands: No silicone lubeswith silicone toys Silicone, water Avoid glycerin, parabens, fragrances, menthol Uberlube Astroglide - – based, based, hybrid 70% , Good Clean , Good Clean Love, , Durex Sliquid , Aloe – Cadobora not justthe vaginanot 4 T H COFFEE more people became curious about BDSM behavior and spicing up behaviorspicing BDSM and about more becamecurious people Greyof manyMay inShades trilogy came 50 out 2011, the When Question #3 D. C. B. A. standBDSM for?Whatdoes sextheir lives. Bondage/Discipline, Bottom/ Sadism/Masochism Domination/Submission,Bondage/Discipline, Danger/Safe,modification/Dipping,Body Sadism/Masochism Domme , Dominant/Sub, Sigmoid/MastersDominant/Sub,, Domme /Sub, Spanking/Mastering /Sub, 4 T H COFFEE • • Answer: B! • • • • • • system similarities toThe pain and pleasure Settingthe “scene” of Informed consent bottoms. Thereare dominants, blindfolds and bondage toolsduring sex adults in Unitedthe States masks,use A 2005 survey byDurex found that 36% practicesBDSM Trust and communicationare paramount in Dating backto AD 300 also Can include Kink behaviors • • • Risk awareRisk consensual kink 18 Greeks and Karma Sutra th century brothels century – safe, andconsensualsane, submissives , tops,and – limbic of of Medical play bondage Japanese Human furniture showers Golden (urinating) Flogging Edgeplay Eroticelectrostimulation and Cockball torture(CBT) Breasttorture Animal roleplay TypesPlay of Wax play Tickle torture Suspension Spanking Sexual roleplay Salirophilia Pussy torture Predicamentbondage Play piercing Paraphilic infantilism 4 T H COFFEE tosexual researchduring activity. what happens After watchingover 1960’sWilliamMasterswhen workedVirginia and Johnson together Understandinglateuntilsexualthe the occur not responsecycle did Question #4 D. C. B. A. sexualthe orderthe Whatis of cycle?response born. sexualencounters,10,000 foursexualtheir phase cycle response was Excitement, arousal,orgasm, multipleorgasm Arousal,excitement, resolution, orgasm Desire,arousal, orgasm, refractory Excitement, plateau,orgasm, resolution 4 T H COFFEE • Answer: A! • • • AlfredKinsey responsecycle Rosemary ResponseCycle adjustmenttoModern Sexual ResponseCycle MastersSexualJohnson and • • • always the beginning Cyclic and spontaneous desire not Desire, arousal, orgasm, resolution Excitement, plateau, orgasm, resolution Basson – firstsex researcher – female sexual 4 T H COFFEE although these companies havecompaniesthese although pocketedof dollars,billions there is forbooming and decadesbeen noveltyhas toy adult The business Question #5 D. C. B. A. early 1900’stocure what disease? vibratorThe wasoriginally developed physicianBritishbya the in inventor.true one only Hallucinations Hysteria Heartburn Headaches 4 T H COFFEE • Answer: C • • • • • Should you prescribe a vibrator? Why use a vibrator? Safe materials =silicone, stainless steel, glass/ Caution in Novelty Stores Vibrators are the #1 sex toy bought by Americans bees…buzz, buzz! Cleopatra was the first documented one to use a gourd filled with Yes, Dr. Swift was the true inventor of the original vibrator, however • • • • • • Improve sexualfunction in co explorationSelf GYN Less concerns boostingImmune Most toysarejelly latex of made out Thereare regulatoryno organizations thatmonitor sex toydevelopment – Hysteria! - morbidities – PVC pyrex – 76% 4 T H COFFEE Women’sSexual HealthTrivia ROUND TWO 4 T H COFFEE to preventsexuallypregnancyand both transmitted infections. have Condoms aroundfor been yearsof hundredsdevicebarrier a as Question #6 D. Rubber Leather C. Plastic B. Bamboo A. discoveredheatcouldhe treat material? which GoodyearCharles came when innovation big The 1839 in tocondoms 4 T H COFFEE • Answer: D • • • • • Female condoms? Durex made the first latex condoms 450 million condoms sold each year in the US year earliestThe known illustration of a man using a condom is a 12,000 First condoms were made from sheepskin Hence…condoms AKA “rubbers” • • • • • • • • When used correctly, can be 95% effective FC2 AKA The London Rubber Company 1920 Distribution during the Olympics condomsAnimal skin are more porous Most are latexor polyurethane First rubber condom in 1855 Goodyear rubber vulcanization 1844 - old painting on thewall of a cave inFrance – can be worn a full 8 hours before used – Rubbers! → HIV acquisitionrisk – 15,000 - 4 T H COFFEE diagnosis to describe the rangetothe diagnosis symptoms describe menopausal of associated a moreappropriatemetISSWSH todiscussand NAMS 2014, In Question #7 D.Syndrome Genitourinary of Menopause Menopause C. Vulvovaginal B. Syndrome of Menopause of EstrogenSigns Genitourinary Deficiency A. followingthe of termWhichagreed the theyis upon? linkedto estrogen deficiency. physicalwith vulva,the of vagina,lowertractchanges andurinary Vulvovagurinary Syndrome 4 T H COFFEE Answer: D Urinary frequency/urgency Dysuria vulvaof orvaginaIrritation/burning/itching Decreasedarousal, orgasm,desire Post Discomfortsexualwith pain or activity Decreasedlubrication sexualwith activity Genitaldryness - coitalbleeding Symptoms – GSM! RecurrentUTIs Introital retraction urethralProminenceof meatus hymenal of remnants Loss Urethraleversion prolapse or fragility/fissures/petechiaeTissue vaginal of rugaeLoss Pallor/erythema minora Labia resorption elasticityDecreased Decreasedmoisture Signs 4 T H COFFEE topicthat providers) many (and people are hesitant to discuss. Whileresearch thatsuggests Question #8 D. Sexual Aversion Disorder Dyspareunia C. Female B. ArousalDisorder Sexual Hypoactive A. DesireDisorder diagnosis? health dysfunction have(comparedwomenmen) of to 43% 34% sexual a health – which of thefollowingwhich is themostsexualcommon sexualdysfunction is common, it isa is common, 4 T H COFFEE • • Answer: A • present: interest/arousal forat least months.6 the followingThree of symptomsmust be also presentlyIt is defined DSM bythe Arousal Disorder Femaleand namedit Sexual Interest and Arousal Disorder (FSIAD) In the2013, DSM Manual Mental of Disorders (DSM)in 1987. (FSD)that focusesdesire, on andwas first definedDiagnosticin the and Statistical Hypoactive sexualdesire disorder isasubsetfemale (HSDD) of sexual dysfunction • • • • • • encounters cues ( encounters Absent/reducedgenitalor Absent/reducedsexual interest/arousal in responseto any internalor external sexual/erotic Absent/reducedsexual excitement/pleasure sexualduringin at activity least 75%of of sexualinitiationNo/reducedunresponsive activity;topartner’s attempt to initiate Absent/reducedsexual/erotic thoughts/fantasies Absent/reducedinterest in sexual activity eg , written,, verbal,visual) - V1,2 was V1,2 released andhas combinedwithFemale HSDD Sexual – HSDD! nongenital - V as the absence of or significantor absence the of as V reduction in sexual sensations during sexualsensations duringin at activity least 75% ofsexual 4 T H COFFEE • EXTRA…EXTRA… Whatreally desire??? is Spontaneous Responsive 4 T H COFFEE approximately 35% of women have analsextried at least in once their life. Fascination play anal with has been long been seen as taboohowever Question #9 E. D. C. B. A. retained rectal object, what is the most important component in play?anal With the most commonsex seen injury in the emergency room being a All of the above An open mind Pelvic floor relaxation Flange Lubricant 4 T H COFFEE • • Answer: E • • Anal Sex 101 Why anal sex? Increase in rectal/anal cancers as less since risky you can’t get pregnant Increased in analplay in adolescents • • • • • • • • Justanus OK too theis withdepthpenetrationCaution of toand needs be consensual time Discuss ahead of externalThe and internal sphincter response rectumThe a vacuum is lube, and Lube, more lube Whynot? Pudendal nerveinnervation – All of the above!All ofthe → → any anal sextoy to needshave a flange the rectumthe naturallynot a is lubricating organ – more women than men – not seen as intercourse and seen → relaxation iskey 4 T H COFFEE been untilbeen recently thatfemale sexualbroughtbeen has tohealth the havemedicationsapproved26 seen for men’s sexual hasn’t It health. WhilegoingFDAfor processthe through approvalbe difficult,wecan Question #10 D. C. B. A. health? manyHow medicationshave approved been for women’s sexual forefrontmedicalthe community.of Ten Five Two Zero 4 T H COFFEE • • Flibanserin Answer: B • • • Bremalanotide • transient hypertension Side effects: dizziness,hyperpigmentation, headache, nausea,flushing, expressed inCNS. melanocortin receptors, including MC1R expressed onmelanocytes and MC4R MOA: Exact mechanism of action unknown. Indication: female hypoactive sexual desire disorder nausea, syncope, xerostomia Side effects: CNS adverse effects,hypotension, somnolence, fatigue, dizziness, receptors receptors, antagonizes dopamine D4 and serotonin 5 MOA: Exact mechanism of action unknown.Agonizes serotonin 5 Indication: female hypoactive sexual desire disorder (2015) (2019) – TWO! Nonselectively - HT2A, 5 HT2A, binds andactivates - HT2B,5 - HT1A - HT2C 4 T H COFFEE Women’sSexual HealthTrivia Final Question 4 T H COFFEE • QuestionFinal • The NOSE! sexualarousal? genitalsthe Besides breasts, and swellspart whatbody other during 4 T H COFFEE And the winner is… And thewinner Come on down fordownCome on yourprize!!! ALL OF YOU!!!ALL OF 4 T H COFFEE • • • References • • • • • • • • Physician Assist 3385 (2018) Clin McKenzie N. FemaleSexual Interest and Arousal Disorder: How We Our Can When Help Patient’s Libido the Brakes.Hits No 10,1063 International Society for theStudy of Women’sSexual and Health The North American Menopause Society. Portman D and nationally representativeprobability sample adult of womenand men. Herbenick and moisturizer composition? Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause:how important vaginalis lubricant Kingsberg Taormino https://www.kinseyinstitute.org/research/faq.php. 10,2018. Accessed December Frequently AskedQuestions to the Kinsey Institute.” "sadomasochism" or dominance and submission (BDSM): data from a national survey. Richters J, Mintz 2014;180:180 Vaccaro C, https://www.cdc.gov/hpv/hcp/clinician Guidelines, CDC LB, Quicksall T. S, et al. S,etal. de Visser RO,Visser de D, Bowling J, Fu T Fellner - The Ultimate toSexGuide Anal forWomen 1068. - 5. Gass A, A, Handbook of Femaleof SexualHandbook Wellnessand Health KE. M. M. Genitourinary syndrome of menopause: newterminology for vulvovaginal atrophy from the Pauls Becoming Rissel CE, CE, et al. Rissel R. FemaleR. sexual function and the clitoral complex MRI using assessment. pelvic September - C(J, Dodge B, Guerra Climacteric – Cliterate 397. Demographic and psychosocial features of participants bondage in and discipline, . 2015;19(2):151. : WhyMattersEquality Orgasm - Reyes L, Sanders S. Sexual diversity theUnitedin States: Results from a The Kinsey Institute forResearch Sex,in Gender,Reproduction and . San . Francisco, CA: - factsheet.html. 2018.10, December Accessed - 161. , www.arhp.org. March Accessed 30,2020. Plos -- Cleis One and How toHowand Get It ; 2006.; . 2017;12(7).. J SexMed. . . NewYork, NY: 2008 Jul;5(7):16602008 Menopause HarperOne - 8. . . Vol . 21, ; 2018. 4 T H COFFEE THANK YOU!