231/232 - Female and Male Sexual Dysfunction Flashcards
List 4 requirements to generate an orgasm
- Arousal
- Physical stimulation
- Adequate blood flow
- Intact neurological system
Basically, central regulation + end organ physical stimulation
Hormones not required!
List 2 phsyical exam findings that are independent predictors of erectile dysfunction
BMI
Waist circumference
In people with a penis, what is the effect of oxytocin?
Pro-erectile
Also involved in orgasm
List 4 risk factors for secondary anorgasmia (in people with a vagina)
- Vascualr disease
- Neurologic disease/neuropathy
- Pelvic floor disorders
- Contractions required for orgasm
- Gynecologic conditions
- Ex: Lichen sclerosis
Which imaging modality is used to assess penile venous leak?
Which method is used to measure arterial insufficiency?
Venous leak: Cavernosometry
Arterial insufficiency: Pudendal angiography
Where in the brain are the neurotransmitters that stimulate libido?
What are they? (3)
Limbic system
- Dopamine
- Melanocortin
- Norepinephrine
Estrogen and testosterone important, but they prime the hypothalamus to respond to the neurotransmitters; cannot stimulate arousal on their own
Limbic system controls emotions, motivations, pleasure
Which neurotransmitter is responsible for facilitating achievement and maintenence of an erection?
Nitric Oxide (NO)
- Mediates vasodialtion -> increased blood flow
- NO -> increased cGMP -> Decreased Ca2+ -> smooth muscle relax
- > increased blood flow*
Which neuotransmitters stimulate arousal? (4)
- Dopamine*
- Norepinephrine*
- Nitric oxide
- Acetylcholine
Result is genital-clitoral engorgement or erection
Also excitatory for libido
What is the “truest assessment” of natural erectile machinery?
Nocturnal erections
- Can differentiate organic vs. psychogenic cause of ED*
- But even people without ED do not have a nocturnal erection every night*
List 3 treatment options for premature ejaculation
- Behavioral therapy
- Stop/start or squeeze
- Transdermal therapy - generally the mainstay
- Numbing creams and sprays
- SSRIs
During an erection, compression of which veins prevents venous return, thus maintining the erection?
Compression of helical veins
Which nerves are responsible for each stage of the male sexual response?
- Arousal:
- Emission:
- Expulsion:
- Orgasm:
- Arousal: Pelvic nerves (Parasympathetic)
- Emission: Sympathetic T10-L2
- Expulsion: Sympathetic S2-S4 + Pudendal
- Orgasm = central control
- Ejaculation = emission + expulsion*
- Emission moves semen from epididymis to urethra*
- Expulsion -> out into the world*
What defnes premature ejaculation?
Ejaculation within 2 minutes of initiation of penetrative sex
w/ associated poor control, bother, with nearly all partners and intercourse attempts
What is the #1 cause of erectile dysfunction?
(Mechanically speaking)
Venous leakage
What is apreunia?
Vagina does not undergo necessary changes to accomodate penetrative intercourse
Which neurotransmitter or hormone is most important for achieving orgasm?
Oxytocin
- Facilitates muscle contractions associated with orgasm
- Secreted by paraventricular nucleus of the hypothalamus
- Oxytocin = #1 facilitator of arousal and orgasm*
- Works synergystically with sex hormones to facilitate muscle contractions*
Which area of the brain is responsible for triggering an erection?
Medial pre-optic area (anterior hypothalamus)
Coordinates brain and penis
PGN will stop sexual response if time is not appropriate
What is more important in generating libido: neurotransmitters or hormones?
Neurotransmitters
Hormones can potentiate neurotransmitter signaling, but need excitatory neurotransmitters (Dopamine, norepinephrine, melanocortin)
MOA of Alprostadil in treating erectile dysfunction
Incrased cAMP production
- -> increased PKA
- -> Decreased Ca2+ (sequestered)
- -> Smooth mucle relaxation
- -> Increased blood flow
What are the first-line treatments for erectile dysfunction? (3)
- Behavior/lifestyle change
- Correct underlying medical issues
- Oral medications
- 2nd line = more invasive; transurethral pellets, vacuum erection, intracavernosal injection*
- 3rd line = Surgical intervention (penile prosthesis*
Which artery supplies the penis?
Pudendal artery
- > Common penile artery
- > Superficial dorsal artery and deep cavernosal artery
MOA of PDE-5 inhiibitors in treating erectile dysfunction
PDE-5 normally degrades cGMP
PDE-5 inhibitors increase endognous cGMP
- cGMP
- -> decreased Ca2+
- -> smooth muscle relaxation
- -> increased blood flow
- -> erection
What percent of people with a vagina can achieve an orgasm without clitoral stimulation?
5-10%
List 4 medical conditions that are associated with erectile dysfunction
- Coronary artery disesae
- Diabetes mellitus
- Poorly controlled HTN
- Dyslipidemia
MOA of Papaverine in treating erectile dysfunction
Inhibits degradation of cAMP
- -> Increased cAMP
- -> Increased PKA
- -> Decreased Ca2+ (sequestered)
- -> Smooth muscle relaxaiton
- -> Blood flow
List 4 medical treatments for delayed orgasm
- Buproprion
- Cyproheptadine
- Amantadine
- Yohimbine
Describe the two pathways to orgasm in a person with a vagina
- Primary
- Clitoral stimulation -> Spinal cord -> brain
- Releases oxytocin -> orgasm
- Alternate
- Vaginal/cervical stimulation -> Vagus/pelvic nerve -> orgasm
Where in the brain are the neurotransmitters that inhibit libido?
What are they? (3)
Prefrontal cortex
- Serotonin
- Prolactin
- Opioids
Makes sense b/c prefrontal cortex regulates compulsive, reward-seeking behavior
Are hormones required for penile/vaginal intercourse?
No - they are helpful, but required
Most important factor is end-organ that is phsyically capable of accomodating intercourse
What defines female sexual dysfuction?
At least one of the following:
- Problems with sexual desire, interest, or arousal
- Orgasmic disorders
- Sexual pain
That results in marked distress or interpersonal difficulty
NOT better explained by another primary psychiatric disorder or general medical condition
TY @Alba Gonzalez!
What is the most common cause of secondary anorgasmia?
SSRIs
List the 3 categories of erectile dysfunction
- Psychogenic/loss of confidence
- Organic
- Mixed
Mixed is most common
What is the difference between libido and arousal?
- Libido
- Desire to have sexual activity
- Mediated by neurotransmitors
- Arousal
- Pysiologic changes that accompany subjective sense of sexual pleasure
- Can be initiated by the brain (visual, auditory, olfactory, fantasy) or physical touching
- Need neurotransmitters, hormones, AND end-organs capable of physiologic changes
What is the difference betwen psychogenic and organic erecticle dysfunction?
- Psychogenic
- Due exclusively to psychological or interpersonal reasons
- The equipment works, but things brain/emotions/relatioships are impacting usage
- Organic
- Change in erectile rigidity due to disease or medication
- Something is interfereing with the equipment
Which neurotransmitters are inhibitory for arousal? (2)
Serotonin
Prolactin
Both are also inhibitory for libido
