19- Human Sexuality

Question 1

What is the traditional model of sexual response?

Answer 1

Desire
Arousal
Plateau- stage of high constant arousal
Peak intensity and release (orgasm)
Resolution

Question 2

What are the limitations with the traditional model?

Answer 2

Assumes the stage of sexual response is linear
Factors/emotions are often more important
Outcomes of the experience influences the willingness to repeat it

Question 3

What is the intimacy base model?

Answer 3

Integrates intimacy as a integral factor of female sexual arousal
More useful than traditional model when thinking about sexual dysfunction in women

Question 4

What are the anatomic changes of aging?

Answer 4

Reduced pubic hair, clitoral, cervical, vaginal and uterine size
Sensory changes in breasts’ breast atrophy
Thinning of vaginal wall, labia minora
Decreased vaginal elasticity
Decreased clitoral, perineal sensitivity

Question 5

What are the effects of aging on sex?

Answer 5

Decreased sexual desire
Increased arousal, stimulation and lubrication time
Less intense orgasms, less likely to be multi orgasmic
No change in ability to have orgasms

Question 6

What are the types of sexual dysfunction?

Answer 6

Hypoactive sexual disorder- desire
Arousal disorder
Orgasmic disorder
Pain disorder

Question 7

What are some organic factors of inhibited sexual desire?

Answer 7

Gynecologic illness
Chronic illness
Pregnancy 
Drugs
Menopause

Question 8

What are some psychosocial factors of inhibited sexual desire?

Answer 8

Relationship conflict
Past sexual trauma
Depression
Substance abuse

Question 9

What it the treatment for hypoactive sexual desire?

Answer 9

Gynecologic- consider HRT in menopausal patient, androgen therapy, stop any anti cholinergics
Psychologic- stop SSRI, relationship issues, use of erotic material(debatable)

Question 10

What is an arousal disorder?

Answer 10

Persistent or recurrent inability to attain or maintain an adequate lubrication until completion of the sexual activity
Causes marked distress or interpersonal difficulty

Question 11

What is dyspareunia?

Answer 11

Pain during sex
Most common dysfunction seen by gyn docs
Interferes with sexual satisfaction

Question 12

What is vaginismus?

Answer 12

Involuntary contraction or spasm of the pelvic floor muscles
Can be primary or secondary
Primary is often relate to some past psychosexual or physical trauma

Question 13

What are the vulvar pain syndromes?

Answer 13

Localized vulvodynia

Generalized vulvodynia

Question 14

What are the characteristics of localized vulvodynia?

Answer 14

Pain syndrome generally localized to the vestibule
Diagnosed by physical exam
Can cause primary or secondary dyspareunia
Treated with topical lidocaine

Question 15

What are the characteristics of generalized vulvodynia ?

Answer 15

Pain syndrome of the entire vulva

Long term treatments consists of vulvar hygiene modification and gabapentin topically or orally

Question 16

What are some causes of dyspareunia post operatively?

Answer 16

Hysterectomy
Posterior colporrhaphy and episiotomy
Inadequate lubrication due to menopause, medications, breastfeeding
Endometriosis
Anorgasmia- inability to achieve orgasm (primary, secondary or situational)

Question 17

What is the treatment for primary anorgasmia?

Answer 17

Individual counseling relying on the patient developing comfort with self pleasuring until she is able to achieve orgasm on her own
Intensive therapy for those with history of sexual trauma

Question 18

What is the treatment for secondary anorgasmia?

Answer 18

Involves more complicated issues related to distress in the relationship
Conjoint assessment and treatment may be required