15 - Femal Sexual Response Flashcards
Sexual response cycle?
Drive Arousal - subconscious - autonomic nervous system - subjective (blood flow and fluids and stuff) Emotional modulators
Pregnancy/postpartum variations of psyiologic sex response?
Fatigue Hormone changes Breast feeding - decreases sex satisfaction Method of delivery
Menopause variations on sex response?
Hypoestrogenic state
- more to follow in chapter 18
Sexual dysfunction stats?
64% - low/no sex desire
35% - difficulty w orgasm
26% - sexual pain
Generally last <6 mo
Psychiatric sexual dysfunction
Painful intercourse Disturbance in - desire - arousal - orgasm - resolution
Sexual dysfunction types?
DSM-5
Female sexual interest/arousal d/o Female orgasmic d/o Genitopelvic pain/penetration d/o Substance/medication-induced sex dysfunction Other
Can be
- lifelong - acquired
- generalized - situational
Psychosocial risk factors for sexual dysfunction?
Comorbid psych d/o Neg emotions Maladaptive conditions Cultural factors Lack of sex ed Couple distress Physical attraction
Phases of sexual response
Desire (libido) - testosterone
Excitement (arousal) - estrogen
Orgasmic - sympathetics
Desire (libido) is moderated by?
Testosterone
- excited by dopamine
- suppressed by serotonin
Hypoactivity - 65% of all sexuality issues
Excitement phase is affected by?
Modulated by parasympathetics
Enhanced by estrogen
Excitement extragenital effects?
HR, BP muscle tension Breast size Areolar engorgement Nipple erection Sex flush (75%)
Most treatable sexual phase d/o?
Orgasmic phase
- its modulated by sympathetics
- optimized by clitoral input
Risk factors for dyspareunia?
Age <50:
- sexual abuse
- hx of PID
- Depression
- anxiety
What is vaginismus?
Involuntary contraction of outer 1/3 of vaginal muscles
Sexual dysfunction w/u?
Hx is key
Eval for physical cause
Eval for psych d/o
Sex dysfunction tx approach?
Multidisciplinary tx team
- load the boat
- gyn, psych, nurse-specialist
- and organic - urology, GI, etc
Psychological approaches dysfunction tx?
Combo of
- sex ed
- communication enhancement
- ID emotional/cultural factors
- cognitive-behavior therapy
- couples therapy
Prevalence of domestic violence?
ER sampling
54% - lifetime
24% - current partner
Sexual assault definition?
Any sexual act w/o consent
- threat/force
- even includes viewing of porn
Sexual assault stats?
Incidence
- 20% under 21 y/o
- 13-39% lifetime
Perpetrators
- 75% know their victim
Injuries
- 70% - no obvious inj
- 24% - minor inj
- 5% - serious inj
Death is rare but fear of death is common
PE for sexual assault?
Use SANE if available Follow the checklist Get consent for exam Chaperone - have one Law enforcement - notification - restricted vs unrestricted reporting
Tx for sexual assault
Injury tx
STD prophylaxis
- GC, non GC
- HBIG/Hep B
- HIV prophylaxis (dependent on risk)
Emergency contraception
- pan B
- anti-emetic
Care after sex assault?
Mental health/counseling referral
Follow up
- 1 week of prophylaxis given
- 2 week if no prophylaxis
(Repeat GC and non-GC)
Other
- syphilis q 6 wks
- HIV 6,12,24 wks
Dont forget safe place to go, transportation etc
Rape trauma syndrome?
Psychologic sequelae
acute/disorganization phase
- hours - days
- distortion/paralysis of coping mechanism
Integration/resolution phase
- months - yrs later
- flashbacks, nightmares, phobias
- gyn/mensural complaints
PTSD
- 50% of rape victims
- Mitigate w acute crisis counseling
Diagnostic criteria for PTSD?
Sx x 1 month Exposure to trauma Re-experience of trauma Avoidance of the trauma Increased arousal Life dysfunction
sex jokes are not funny. Period!
Bruh! Its not funny i mean cum on people
