Treatment Options for the Patient with Sexual Arousal Concerns
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Outline what key questions to ask to clarify a patient’s arousal response 2. List treatment options for this condition
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Arousal problems occur when women do not experience the usual sexual response to the introduction of sexual stimulation.
Obtain a history to better understand the problem
Ascertain that the problem is arousal, rather than desire/libido
Clarify woman’s arousal response by asking about lubrication, mental interest, tingling or swelling normally experienced by the patient
Consider treatment with medications, but benefit may also be gained by simultaneous referral to a sex therapist
Women describe problems with sexual arousal in a variety of ways: an inability to “quiet the laundry list” in their brains, or a marked absence of the swelling and tingling often felt with sexual arousal. Absent too may be the lubrication that women have experienced in the past. Often they will describe it as “nothing happening down there.” Once the possibility of the problem being desire rather than arousal has been excluded (see differential diagnosis desire/arousal) there are a number of treatments that can be effective.
Assess whether the problems with arousal is due to side effects of medications and if that is the case, consider whether those medications should be reduced or discontinued under the guidance of the prescribing physician
SSRIs and SNRIs can often cause arousal problems in women
Oral contraceptive pills can also affect a woman’s ability to become aroused. Sometimes women will describe the feeling as “being covered in a slipcover”
Treatment options include:
Bupropion xl 150 mg daily, increase if needed, to twice daily up to 300 mg per day
Introduction of strong vibrator
While some advocate for the use of PDE5 (phosphodiesterase type 5) inhibitors, used for male erectile dysfunction, ACOG does not recommend use of these drugs without further study
Education is needed in those cases where, due to medication or age, more direct or higher levels of stimulation are needed and perfectly natural
Consider referral to a sex therapist to recommend or discuss practical solutions to increasing mental and physical stimulation
A sex therapist may help the patient to take more time and can suggest use of erotica, fantasy or vibrators
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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