23. Sexe Flashcards

1
Q

broad topics about sex

A

normal sexuality,
safe sex,
contraception,
sexual orientation,
sexual dysfunction

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2
Q

which pt are high risk for sexual dysfunction

A

post infarctus
pt diabétiques
pt aevc maladies chorniques

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3
Q

définition dysfonction érectile

A

Incapacité persistante ou récurrente d’obtenir et de maintenir une érection pénienne suffisamment rigide pour permettre une activité sexuelle satisfaisante pendant au moins 3 mois.

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4
Q

Sexual hx taking (5)

A

Partner/preferences/contraception

Desire/libido

Opportunity

Obtaining/maintaining erections

Orgasm, Ejaculation, Pain

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5
Q

Cardiac risk factors 5

A

smoking, diabetes, hypertension, obesity, hyperlipidemia

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6
Q

Other hx elements (medical)

A

Rx: ROH cocaine
Rx: antidepressants, antihypertensives
past Mhx
spinal cord injuries, pelvic and prostate surgery, trauma or radiation
premature ejaculation
hypogonadism
peyronie’s disease (fibrosis of penis)

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7
Q

Psychogenic factors 7

A

Nocturnal/morning erections

Erections during masturbation or with alternate partners

Situational variability (eg. improved while on vacation)

Psychosocial stressors, partner relationship

Concern about poor sexual function (performance anxiety)

Previous traumatic sexual experience

Depression

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8
Q

Physical exam (5 categories)

A

Vitals (blood pressure)
ABI

Gynecomastia

Genital exam
Decreased male hair distribution
Peyronie’s disease
Small testes

Peripheral vascular exam
Abdominal, femoral bruits
Peripheral pulses

Neurologic
Pelvic sensation
Anal sphincter tone
Prostate Exam

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9
Q

investigations cardiac risks

A

A1C
lipid profile

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10
Q

when to monitor testosterone

A

hypogonadism, young age, or suspect libido/ejaculatory disorder

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11
Q

what to do if low testosterone

A

ask for:

free testosterone
sex hormone binding globulin (SHBG) levels

prolactin (pituitary)

LH, FSH (testicular failure)

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12
Q

prolactin high - what to do

A

imaging of pituitary

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13
Q

testicular failure definition and what to give

A

High LH and FSH (aka pituitary works well)

Low T (aka testicules do not produce it)

testosterone replacement therapy if no prostate cancer (consider DRE and PSA in age >45yo)

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14
Q

ED tx (5)

A

Treat underlying medication condition (medication adherence)

Lifestyle modification (stop smoking, weight loss if overweight)

Medication review

If psychogenic cause suspected consider sex therapy/psychiatric referral AND/OR trial of medical therapy

If neurogenic or vasculogenic causes suspected consider trial of medical therapy

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15
Q

Rx contraindications to PDE-5 inhibitors (5)

A

nitrates (eg. nitroglycerin)
severe CHF
unstable angina
hypotension
recent stroke/MI

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16
Q

Phosphodiesterase type-5 inhibitors (PDE5-inhibitors) examples

A

Sildenafil (Viagra) 25, 50, 100 mg once daily 1 hour before sexual activity PRN

Tadalafil (Cialis) 5, 10, 20mg PO PRN or daily (longer half life)

Vardenafil (Levitra)

17
Q

other options besides PDE-5 inhibitors

A

intracavernosal vasodilator injection,

vacuum erection pump device

18
Q

testosterone monitoring

A

Surveillance for prostate cancer (yearly rectal examinations and PSA)

Detection of polycythemia (measuring hematocrit every six to 12 months)

Decrease testosterone dose if hematocrit rises above the normal range

19
Q

Dyspareunia ddx 9

A

genitourinary syndrome of menopause
vaginismus - pelvic floor muscles contraction/dysfunction
vulvodynia - discomfort around the outer part of the female genitals
vulvar vestibulitis

PID
endometriosis
vulvar fissures
dermatose
pudendal neuralgia (dommage au nerf innervant la region)

20
Q

what is vulvar vestibulitis

A

Type of vulvodynia

severe pain during attempted vaginal entry (intercourse or tampons insertion)

tenderness to pressure localized to the vulvar vestibule

redness of the vulvar vestibule

21
Q

investigations - female

A

PRN

Pelvic ultrasound

STI screen

CBC, TSH, prolactin

22
Q

Tx - female

A

Pelvic physical therapists
Sex therapist, CBT
vaginal lubricants or local estrogen
directed masturbation if anorgasmia
change Rx / adjunct

23
Q

age of consent

A

18 years for exploitative (prostitution, pornography or relationship of trust, authority or dependency)

16 years for non-exploitative

14 years up to 5 years older

12 years up to 2 years older