H.Soehartono DS,dr,SpOG, KFER Bag / SMF. Obstetri & Ginekologi FK UNAIR / RSU Dr.

Soetomo SURABAYA 2004

MASALAH SEKSUALITAS

TIDAK SAMA PADA SETIAP INDIVIDU

SANGAT INDIVIDUAL

DEFINITIONS USED IN EPIDEMIOLOGIC STUDIES

Low-Dose Oral Contraceptives

Products containing less than 50 g ethinyl estradiol

First Generation Oral Contraceptives Products containing 50 g or more of ethinyl estradiol

Second Generation Oral Contraceptives Products containing levonorgestrel, norgestimate, and other members of the norethindrone family and 30 or 35 g ethinyl estradiol

Third Generation Oral Contraceptives Products containing desogestrel or gestodene with 20 or 30 g ethinyl estradiol

MACAM-MACAM PIL ORAL

Monofasik Progesteron Estrogen Bebas hormon

Bifasik

Bebas hormon

Trifasik

Bebas hormon

Mini Pil

Progesteron saja

ORAL CONTRACEPTIVE

LIBIDO

LIBIDO

FEEL FREE

HORMONAL

SEX HORMONE BINDING GLOBULIN

( S.H.B.G PROTEIN )

MENGIKAT ANDROGEN
( TESTOSTERONE )

LONG TERM USE ORAL PILL ESTROGEN

SHBG

BOUND TESTOSTERONE

FREE TESTOSTERONE

LONG TERM USE ORAL PILL PROGESTERON P450 LIVER ENZYME 17 HYDROXILASE & 17, 20 LYASE 17 OH-PROG ANDROSTENEDIONE TESTOSTERONE
LIBIDO & ORGASMIC DYSFUNCTION

TESTOSTERONE DEFICIENCY

Sexual drive
Sense of well being

Sensitivity in the clitoris

Sensitivity in the nipples Sexual arousal & capacity for orgasm

EVERY WOMENS SEXUAL EXPERIENCE

INDIVIDUAL & UNIQUE

NO TWO WOMEN WILL REACT IDENTICALLY

SEXUAL - FEELINGS SEXUAL - DESIRES

STILL EXIST UNTILL DIE

QUALITY OF SEXUALITY

SEXUALITY IS A COMPLEX PROCESS

COORDINATED BY

- NEUROLOGIC VASCULAR ENDOCRINE SYSTEMS - ENVIRONMENT

FEMALE SEXUAL DYSFUNCTION

MULTICAUSAL & MULTIDIMENSIONAL MEDICAL PROBLEM

SEXUAL AROUSAL DISORDER (SAD)

&

FEMALE ORGASMIC DISORDER (FOD)

PARTNER HORMONAL ATTITUDES QUALITY OF LIFE RELIGIOUS-BELIEFS PHYSCOLOGICAL P SEXUAL KNOWLEDGE SEXUAL EXPERIENCES PHYSIOLOGIC CHANGES MENOPAUSAL SYNDROM DISEASES-HEALTH STATUS ETC

HUNTER M.S (2002)

SEXUAL FUNCTIONING

1. SEXUAL DESIRE, INTEREST OR LIBIDO;

2. FREQUENCY OF SEXUAL ACTIVITY, SUCH AS SEXUAL FANTASIES AND INTERCOURSE; 3. AROUSAL, REFLECTED BY VAGINAL LUBRICATION, RESPONSIVENESS, VAGINAL BLOOD FLOW,

4. ORGASM, ENJOYMENT AND FREQUENCY;

5. SATISFACTION WITH SEXUAL EXPERIENCES AND WITH SEXUAL RELATIONSHIP; 6. PARTNERS SEXUAL FUNCTIONING.

LOVE MAKING

FORE PLAY
INTIMACY

SUFFICIENT AROUSAL
ACHIEVES ORGASM

SEXUAL AROUSAL
IF MIND SAYING YES ABSENCE OF ORGASM FEMALE ORGASMIC DISORDER (FOD)

BODY ISNT LISTENING

SEXUAL AROUSAL DISORDER (SAD)

KAPLAN 1979 & THIEDKE 2002

LIBIDO

AROUSAL

ORGASM

SATISFACTION

DISORDERS OF DESIRE
LACK OF

ESTROGEN
DIRECT -- UNCLEAR

TESTOSTERON DIRECT ROLE IN SEXUAL DESIRE MOOD

INDIRECT
UROGENITAL ATROPHY VASOMOTOR

SEXUAL DESIRE
ESTROGEN

DIRECT

INDIRECT

UNCLEAR

VAGINAL ATROPHY & LUBRICATION

NEUROTRANSMITTERS EPINEPHRINE & NOREPINEPHRINE

VASOMOTOR PROBLEMS

BRAIN

ANDROGEN

TESTOSTERONE

EFFECT ON THE BRAIN

ANDROGEN RECEPTORS & AROMATIZATION TO ESTRADIOL

TESTOSTERON

* METHYLTESTOSTERONE

1,25 2,5 mg

* MICRONIZED TESTOTERONE
* TESTOSTERONE PROPIONATE

2,5 mg

AROUSAL DISORDER

UROGENITAL ATROPHY

IN ADEQUATE STIMULATION

ADEQUATE FOREPLAY & VIBRATORS

TESTOSTERONE

ORGASMIC DISORDER

SEXUAL EXPERIENCE

NEVER EXPERIENCED ORGASM

ORGASMIC CHANGES

DYSPAREUNIA PSYCHOLOGICAL PROBLEMS

PARTNER SEXUAL LIFE STYLE

DYSPAREUNIA SEX PAIN DISORDERS

SUPERFICIAL
PENETRATION IRRITATIVE (EPITHEL ATROPHY) VAGINISMUS

VAGINAL
FRICTION LUBRICATION AROUSAL DISORDERS

DEEP
PELVIC DISEASE OR RELAXATION

KESIMPULAN

MASALAH SEKSUALITAS SANGAT KOMPLEKS MULTI CAUSAL

KESIMPULAN
PENGARUH ORAL PIL TERHADAP SEKSUALITAS

SANGAT INDIVIDUAL

BERBEDA PADA WANITA SATU DENGAN LAINNYA