16. Sexuality and Sexual Dysfunction.

Question 1

Name steps: Sexual response (4)

Answer 1

• desire
• arousal
• orgasm
• resolution

Question 2

Define this step of sexual response: Desire (1)

Answer 2

• energy that allows an individual to initiate or respond to sexual stimulation

Question 3

Define this step of sexual response: Arousal (1)

Answer 3

• physical and emotional stimulation leading to breast and genital vasodilation and clitoral engorgement

Question 4

Define this step of sexual response: Orgasm (1)

Answer 4

• physical and emotional stimulation is maximized, allowing the individual to relinquish their sense of control

Question 5

Define this step of sexual response: Resolution (1)

Answer 5

most of the congestion and tension resolves within seconds, complete resolution may take up to 60 min

Question 6

Name etiologies: Sexual dysfunction (6)

Answer 6

• psychological or emotional: depression, abuse
• hormonal: menopause
• neurologic dysfunction: spinal cord injury
• vascular insufficiency: DM
• drug side effects: β-blockers
• trauma: episiotomy

Question 7

Classify: Sexual dysfunction (4)

Answer 7

• lack of desire (60-70% of women)
• lack of arousal
• anorgasmia (5-10%)
• dyspareunia (3-6%): painful intercourse, superficial or deep

Question 8

Describe: anorgasmia (2)

Answer 8

• primary anorgasmia: never before achieved orgasm under any circumstances
• secondary anorgasmia: was able to achieve orgasms before but now unable to

Question 9

Name ddx: dyspareunia (5)

Answer 9

• vaginismus (15%)
• vulvodynia
• vaginal atrophy
• vulvar vestibulitis: associated with history of frequent yeast infections
• PID

Question 10

Describe: Approach to dyspareunia (figure)

Answer 10

Question 11

Describe: Dyspareunia cycle (Figure)

Answer 11

Question 12

Describe treatment: Lack of desire (4)

Answer 12

• assess factors
• rule out organic causes
• relationship therapy
• sensate focus exercises

Question 13

Describe treatment: Anorgasmia (3)

Answer 13

• self-exploration/pleasuring
• relationship therapy if needed
• bridging techniques (different sexual positions, clitoral stimulation during intercourse)

Question 14

Describe treatment: Dyspareunia (9)

Answer 14

• Kegel and reverse Kegel exercises
• dilator treatment
• comfort with self-exam
• psychotherapy, other behavioural techniques
• female on top position: allows for control of speed and duration
• vestibulitis: remove local irritants, change in contraceptive methods, dietary changes (increased citrate, decreased oxalate), and vestibulectomy (rare)
• vulvodynia: local moisturization, cold compresses, systemic nerve-blocking therapy (amitriptyline, gabapentin) orally or topically, topical anesthetics, estrogen cream
• pain clinic
• removal of environmental factors: bubble baths, soaps, perfumes, sanitary pads with plastic lining

Question 15

Describe: Kegel Exercises (1)

Answer 15

Regular contraction and relaxation to strengthen pelvic floor muscles

Question 16

Describe: Reverse Kegel Exercises (1)

Answer 16

1 s contraction then 5 s of relaxation