Your Patient’s Orgasm Has Disappeared – Next Steps
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. Demonstrate that the condition is secondary anorgasmia 2. Define clinical scenarios that would be included under the diagnosis of secondary anorgasmia
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 faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
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.
Secondary anorgasmia describes a situation in which a woman used to achieve orgasm and over time her response has weakened or dissipated. If you identify this concern, or a patient reports this problem
Take the time to ascertain that the patient is indeed describing secondary anorgasmia
Assess if the problem is secondary to medications
In those situations where a patient is able to achieve orgasm in some way, but they are concerned because they are unable to achieve orgasm using penile/vaginal stimulation alone, psychoeducation is needed to assure them that they are perfectly normal as this is the case with 70% of women
Secondary anorgasmia is fundamentally much easier to treat than primary anorgasmia and can often be resolved with medication or behavioral treatment fairly effectively. Various treatment options can be offered and discussed with the patient.
Secondary anorgasmia can describe a situation in which one of the following scenarios is occurring:
It takes a woman significantly more time than it previously did to achieve orgasm
Orgasms are weak or almost non-discernable
A woman cannot reach orgasm at all
Assess whether the secondary anorgasmia is due to side effects of medications
Selective serotonin re-uptake inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) often cause secondary anorgasmia in women
Oral contraceptives can also affect a woman’s ability to achieve orgasm
Treatment options include:
Bupropion HCl, particularly if anorgasmia is caused by antidepressants
150 mg daily, increase if needed, increase to twice daily dosage up to 300 mg
Can take up to 2 weeks for results
May take 3-6 months for results
If secondary anorgasmia determined to be due to medication side effects, consider modification:
Discontinuation of oral contraceptives
Reduction of SSRI, if possible and under the guidance of the prescribing physician
Introduction of strong vibrator
While some authors suggest introduction of phosphodiesterase type 5 (PDE5) inhibitors, which is commonly used in men for erectile dysfunction, ACOG states that more research is required to determine efficacy before a recommendation for use in women can be made
Education is important in those cases where, due to medication or age, more direct or higher levels of stimulation are needed so that the patient understand that this is not uncommon
Generally, referral to a psychotherapist may not be required as this is rarely a purely psychological issue
Referral to a sex therapist if patient interaction does not allow time for discussion, or to benefit from expertise to discuss vibrator use
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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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