SEXUAL HEALTH

Butler University: Women’s Health Elective

Presented by: PGY1-Resident Morgan Dermody, PharmD, MBA
November 18, 2022
 A B O UT M E

Giant’s Causeway
Originally from St. Louis, MO
Northern Ireland
Graduated from St. Louis College of Pharmacy
PGY-1 Resident at Community Health
Network
Practice Interests: ambulatory care, women’s
health, pediatrics
Busch Stadium
St. Louis, MO

Diving off Black Rock

Ka’anapali, Hawaii
 SEXUAL HEALTH

Butler University: Women’s Health Elective

Presented by: PGY1-Resident Morgan Dermody, PharmD, MBA
November 18, 2022
 SEXUAL HEALTH

• Goals for today’s discussion:

• Understand sexual health in the context of women’s health
• Explain sexual health topics in the context of women’s health
• Apply discussion to a patient case on sexual health
WHAT IS SEXUAL HEALTH?

Poll Everywhere:
https://pollev.com/morgandermody588
 SEXUAL HEALTH

• According to the CDC, the World Health Organization defines

sexual health as:
• “[…] a state of physical, emotional, mental and social well-being in
relation to sexuality; it is not merely the absence of disease, dysfunction or
infirmity. Sexual health requires a positive and respectful approach to sexuality
and sexual relationships, as well as the possibility of having pleasurable and safe
sexual experiences, free of coercion, discrimination and violence.”

Centers for Disease Control. Sexual Health. 2019.


S E X UAL HE A LTH: C A S E
A PPL IC ATION
Apply your knowledge of sexual health
to the following case information:
• Lisa is a 22 year old female who is coming to
your clinic today seeking a reliable form of
contraception.
• You, the pharmacist, inquire more about her
sexual health history, contraceptive
preferences, and other pertinent medical
information.
• Lisa explains that she is in a stable
monogamous relationship and is not always in
the mood to be intimate with her partner,
however, “I do it anyways because he insists,
even when I’m not in the mood. I just don’t
want to get pregnant right now… Maybe
someday.”
• She goes on to explain she desires a highly
effective form of contraception, has not
received any recent vaccines she can
remember,has no allergies, and has never had a
pap smear.
 SEXUAL HEALTH

• No, Lisa is not experiencing positive sexual health in her current

situation.
o Someone coercing their partner into sexual activity, even in committed
relationships, does not fit the definition of sexual health.
o Sexual experiences must be free from coercion in order to be considered
sexually healthy.

Centers for Disease Control. Sexual Health. 2019.

 SUPPORTING SEXUAL HEALTH

• How do you address a situation like Lisa’s?

o Offer emotional support, utilize active listening to show her that her concerns are heard and allow her
the chance to open up about her experiences.
o Encourage the patient to seek out emotional help.
– Remember, emotional wellbeing and mental health are KEY aspects of sexual health,
• Free mental health resources can be found on the CDC’s website:
o Find a psychiatrist via the American Psychiatric Association Foundation
o Find a psychologist via the American Psychological Association
o Plus many more resources!
Centers for Disease Control. Sexual Health. 2019.
Centers for Disease Control. People Seeking Help. 2022.
Centers for Disease Control. Adult Mental Health. 2022.
HYPOACTIVE SEXUAL DESIRE
DISORDER
 HYPOACTIVE SEXUAL DESIRE DISORDER
(HSDD)

• DSM-IV-TR defines HSDD as “a • Updated DSM-5 criterial merged two

persistent or recurrent absence of female sexual dysfunction disorders
sexual fantasies and desires for into female sexual interest/arousal
sexual activity, which causes marked disorder, thus eliminating HSDD and
personal distress or interpersonal female sexual arousal disorder.
difficulties”
• Studies on HSDD treatment utilized
• Classifications of HSDD include: the DSM-IV-TR criteria.
lifelong vs. acquired and generalized
vs. situational

Pancho Pesantez GS. Treatment of hypoactive sexual desire disorder among

women: general considerations and pharmacological options. 2021
 H YPOACTIVE S EXUAL
D ES I RE D I S ORDER
TREATMENT

Flibanserin:
• Brand Name: Addyi
• FDA Approval: 2015
• MOA: Agonism of serotonin 1A (5HT1A) receptor
and antagonism of serotonin 2A (5HT2A) to
reduce serotonin inhibition of excitatory
neurotransmitters. This mechanism produces
indirect increases in the release of dopamine and
norepinephrine.
• ADE: dizziness, somnolence, nausea, fatigue, Image 1
insomnia, dry mouth, hypotension, and somnolence
• Interactions: metabolized by CYP3A4 and 2C19
Pancho Pesantez GS. Treatment of hypoactive sexual desire disorder among
women: general considerations and pharmacological options. 2021
 H YPOACTIVE S EXUAL
D ES I RE D I S ORDER
TREATMENT

Bremelanotide:
• Brand Name: Vyleesi
• FDA Approval: 2019
• MOA: Agonism of melanocortin 4 receptor
(MC4R). Bremelanotide’s exact mechanism of
improving HSDD is unknown; however, it is
thought to enhance dopamine and norepinephrine
activity to increase excitation.
• ADE: nausea, flushing, headache, vomiting, injection
site reactions, transient increases in blood pressure
Image 2
• Interactions: Significantly decreases absorption of
oral naltrexone, concurrent use not recommended
Pancho Pesantez GS. Treatment of hypoactive sexual desire disorder among
women: general considerations and pharmacological options. 2021
SEXUAL HEALTH

PREVENTATIVE MEASURES
 SEXUAL HEALTH AND PREVENTION

• Another piece of sexual health is the prevention of disease.

o In women that prevention is often in the form of cervical
cancer prevention.
• The absence of disease does not define sexual health alone,
it remains a key component of sexual health.
• Preventative screenings for cervical cancer in women
include:
o Papanicolaou smears (Pap test)
o Primary HPV Testing
 S E X UAL HE A LTH A N D
PR E V ENTI ON

The American Cancer Society updated

their guidelines for recommendations
of cervical cancer screening in the
Cervical Cancer Screening for
Individuals at Average Risk: 2020
Guideline Update from the American
Cancer Society.

National Cancer Institute. ACS’s Updated Cervical Cancer Screening

Guidelines Explained. 2020.
 HPV TEST VS. PAP SMEAR

HPV TEST PAP SMEAR

• Conducted with a scraper or brush to • Conducted with a scraper or brush to

collect cells from the cervix. collect cells from the cervix.
• Looks for human papillomavirus itself • Looks for abnormal cells of the cervix
in the cells of the cervix. that can lead to cervical cancer.

National Cancer Institute. ACS’s Updated Cervical Cancer Screening

Guidelines Explained. 2020.
 • In your discussion with Lisa you
recommended that she receive screening for
HPV when she turns 25.
S E X UAL HE A LTH: C A S E
• Lisa gives you a puzzled look and asks you to
A PPL IC ATION
explain what HPV is further.
• She states she does not know a lot about
Lisa’s visit continued: HPV and wants to know if there is anything
she can do to protect herself from an HPV
infection.
 SEXUAL HEALTH: HPV

• Human papillomavirus (HPV):

o 200+ types of HPV exist
o Double-stranded deoxyribonucleic acid viruses (DNA viruses)
o Responsible for almost all cases of cervical cancer.
– HPV 16 accounts for approximately 50% of all HPV related cervical
cancers
– HPV 18 accounts for approximately 20% of all HPV related cervical
cancers
o Responsible for vulvar and vaginal cancers, genital warts, anal cancers,
oropharyngeal cancers, and even penile cancers.
Palefsky JM. UpToDate. 2020.
 S E X UAL HE A LTH: HPV

• Prevention strategies include:

• Consistent use of barrier
methods (i.e. condoms, dental
dams) to prevent against
physical transmission of HPV
between partners.
• Administration of an
appropriate vaccine series to
prevent against HPV infection. Image 3

Palefsky JM. UpToDate. 2020.

 HPV VACCINE SERIES
AGE 9-14 AT INITIAL
VACCINATION
• 2-dose series at 0, 6–12 months
• Minimum interval: 5 months
o Repeat dose if administered too soon.
• Vaccination is routinely recommended at
age 11-12 years, but can start as young as
9 years of age.
Child and Adolescent Immunization Scheduled. Centers for Disease Control and Prevention. 2022.
AGE 15+ AT INITIAL
VACCINATION
• 3-dose series at 0, 1–2 months, 6 months
• Minimum intervals:
o Dose 1 to dose 2: 4 weeks
o Dose 2 to dose 3: 12 weeks
o Dose 1 to dose 3: 5 months
– Repeat dose if administered too soon.
• Recommendations for vaccination at age
26-45 include a 3 dose series based on
shared clinical decision making.
Adult Immunization Scheduled. Centers for Disease Control and Prevention. 2022.
SEXUAL HEALTH RESOURCES AND
CONCLUSION
 • Links to sexual heath focused organizations
and associations:
o American Sexual Health Association
o Global Pelvic Health Alliance Membership
o The Sexual Health Alliance
T HE S E X UAL HE A LTH o PLUS many more!
PHA R MAC IST
• Links to patient educational resources and
products:
A website dedicated to providing
o Functional Health Coaches
informational links about sexual health
for both patients and providers. o Pelvic Floor Therapists

Available at: o Rosy Wellness link – a FREE app and resource

center for women’s sexual wellness
The Sexual Health Pharmacist
o STD Testing in Your Area – Free, Fast, and
Confidential Testing Near You.
 SEXUAL HEALTH CONCLUSION

• Sexual health is a large field of healthcare, encompassing the entire person

o This includes physical, emotional, mental and social well-being in relation to
sexuality.
• Pharmacists must ensure they are aware of multiple aspects of a patient’s care
opportunities, not just medications.
o Stay up-to-date on preventative screening recommendations for patients.
– Opportunities to counsel patients on these recommendations will continue to
grow as pharmacists see more patients for contraception and vaccine
administration.
o Be knowledgeable on vaccine series schedules and recommended dosing intervals.
o Be able to point patients in the appropriate direction for sexual health resources.
 REFERENCES

1. Sexual Health. Centers for Disease Control and Prevention. June 25, 2019. Accessed October 30, 2022. https://www.cdc.gov/sexualhealth/Default.html
2. National Cancer Institute. ACS’s Updated Cervical Cancer Screening Guidelines Explained. September 18, 2020. Accessed October 30, 2022.
https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-
guideline#:~:text=ACS%20recommends%20cervical%20cancer%20screening,Pap%20test%20every%203%20years.
3. Fontham, ETH, Wolf,AMD, Church, TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer
J Clin. 2020;70:321-346. https://doi.org/10.3322/caac.21628.
4. Palefsky JM. UpToDate. Human papillomavirus infections: epidemiology and disease associations. June 17, 2022. Accessed October 30, 2022.
https://www.uptodate.com/contents/human-papillomavirus-infections-epidemiology-and-disease-
associations?search=what%20is%20hpv&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
5. Image 1. Women vaccinating a child. Accessed October 30, 2022. https://www.cedars-sinai.org/blog/vaccines-during-covid-19.html
6. Child and Adolescent Immunization Schedule. Centers for Disease Control and Prevention. February 17, 2022. Accessed October 30, 2022.
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#note-hpv
7. Adult Immunization Schedule. Centers for Disease Control and Prevention. February 17, 2022. Accessed October 30, 2022.
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-hpv
8. Pachano Pesantez GS, Clayton AH. Treatment of hypoactive sexual desire disorder among women: general considerations and pharmacological options. Focus (Am
Psychiatr Publ). 2021;19:39-45.
9. People Seeking Help. Centers for Disease Control and Prevention. March 7, 2022. Accessed November 8, 2022. https://www.cdc.gov/mentalhealth/tools-
resources/individuals/index.htm
10. Adult Mental Health. Centers for Disease Control and Prevention. May 9, 2022.Accessed November 8, 2022. https://www.cdc.gov/mentalhealth/tools-
resources/adults/index.htm
QUESTIONS?

Thank you!