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Repro/GU by Minnie (she/her) > 231/232 - Female and Male Sexual Dysfunction > Flashcards

231/232 - Female and Male Sexual Dysfunction Flashcards

1
Q

List 4 requirements to generate an orgasm

A
  • Arousal
  • Physical stimulation
  • Adequate blood flow
  • Intact neurological system

Basically, central regulation + end organ physical stimulation

Hormones not required!

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2
Q

List 2 phsyical exam findings that are independent predictors of erectile dysfunction

A

BMI

Waist circumference

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3
Q

In people with a penis, what is the effect of oxytocin?

A

Pro-erectile

Also involved in orgasm

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4
Q

List 4 risk factors for secondary anorgasmia (in people with a vagina)

A
  • Vascualr disease
  • Neurologic disease/neuropathy
  • Pelvic floor disorders
    • Contractions required for orgasm
  • Gynecologic conditions
    • Ex: Lichen sclerosis
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5
Q

Which imaging modality is used to assess penile venous leak?

Which method is used to measure arterial insufficiency?

A

Venous leak: Cavernosometry

Arterial insufficiency: Pudendal angiography

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6
Q

Where in the brain are the neurotransmitters that stimulate libido?

What are they? (3)

A

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

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7
Q

Which neurotransmitter is responsible for facilitating achievement and maintenence of an erection?

A

Nitric Oxide (NO)

  • Mediates vasodialtion -> increased blood flow
  • NO -> increased cGMP -> Decreased Ca2+ -> smooth muscle relax
  • > increased blood flow*
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8
Q

Which neuotransmitters stimulate arousal? (4)

A
  • Dopamine*
  • Norepinephrine*
  • Nitric oxide
  • Acetylcholine

Result is genital-clitoral engorgement or erection

Also excitatory for libido

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9
Q

What is the “truest assessment” of natural erectile machinery?

A

Nocturnal erections

  • Can differentiate organic vs. psychogenic cause of ED*
  • But even people without ED do not have a nocturnal erection every night*
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10
Q

List 3 treatment options for premature ejaculation

A
  • Behavioral therapy
    • Stop/start or squeeze
  • Transdermal therapy - generally the mainstay
    • Numbing creams and sprays
  • SSRIs
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11
Q

During an erection, compression of which veins prevents venous return, thus maintining the erection?

A

Compression of helical veins

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12
Q

Which nerves are responsible for each stage of the male sexual response?

  • Arousal:
  • Emission:
  • Expulsion:
  • Orgasm:
A
  • 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*
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13
Q

What defnes premature ejaculation?

A

Ejaculation within 2 minutes of initiation of penetrative sex

w/ associated poor control, bother, with nearly all partners and intercourse attempts

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14
Q

What is the #1 cause of erectile dysfunction?

(Mechanically speaking)

A

Venous leakage

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15
Q

What is apreunia?

A

Vagina does not undergo necessary changes to accomodate penetrative intercourse

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16
Q

Which neurotransmitter or hormone is most important for achieving orgasm?

A

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*
17
Q

Which area of the brain is responsible for triggering an erection?

A

Medial pre-optic area (anterior hypothalamus)

Coordinates brain and penis

PGN will stop sexual response if time is not appropriate

18
Q

What is more important in generating libido: neurotransmitters or hormones?

A

Neurotransmitters

Hormones can potentiate neurotransmitter signaling, but need excitatory neurotransmitters (Dopamine, norepinephrine, melanocortin)

19
Q

MOA of Alprostadil in treating erectile dysfunction

A

Incrased cAMP production

  • -> increased PKA
  • -> Decreased Ca2+ (sequestered)
  • -> Smooth mucle relaxation
  • -> Increased blood flow
20
Q

What are the first-line treatments for erectile dysfunction? (3)

A
  • 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*
21
Q

Which artery supplies the penis?

A

Pudendal artery

  • > Common penile artery
  • > Superficial dorsal artery and deep cavernosal artery
22
Q

MOA of PDE-5 inhiibitors in treating erectile dysfunction

A

PDE-5 normally degrades cGMP

PDE-5 inhibitors increase endognous cGMP

  • cGMP
  • -> decreased Ca2+
  • -> smooth muscle relaxation
  • -> increased blood flow
  • -> erection
23
Q

What percent of people with a vagina can achieve an orgasm without clitoral stimulation?

A

5-10%

24
Q

List 4 medical conditions that are associated with erectile dysfunction

A
  • Coronary artery disesae
  • Diabetes mellitus
  • Poorly controlled HTN
  • Dyslipidemia
25
Q

MOA of Papaverine in treating erectile dysfunction

A

Inhibits degradation of cAMP

  • -> Increased cAMP
  • -> Increased PKA
  • -> Decreased Ca2+ (sequestered)
  • -> Smooth muscle relaxaiton
  • -> Blood flow
26
Q

List 4 medical treatments for delayed orgasm

A
  • Buproprion
  • Cyproheptadine
  • Amantadine
  • Yohimbine
27
Q

Describe the two pathways to orgasm in a person with a vagina

A
  • Primary
    • Clitoral stimulation -> Spinal cord -> brain
    • Releases oxytocin -> orgasm
  • Alternate
    • Vaginal/cervical stimulation -> Vagus/pelvic nerve -> orgasm
28
Q

Where in the brain are the neurotransmitters that inhibit libido?

What are they? (3)

A

Prefrontal cortex

  • Serotonin
  • Prolactin
  • Opioids

Makes sense b/c prefrontal cortex regulates compulsive, reward-seeking behavior

29
Q

Are hormones required for penile/vaginal intercourse?

A

No - they are helpful, but required

Most important factor is end-organ that is phsyically capable of accomodating intercourse

30
Q

What defines female sexual dysfuction?

A

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!

31
Q

What is the most common cause of secondary anorgasmia?

A

SSRIs

32
Q

List the 3 categories of erectile dysfunction

A
  • Psychogenic/loss of confidence
  • Organic
  • Mixed

Mixed is most common

33
Q

What is the difference between libido and arousal?

A
  • 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
34
Q

What is the difference betwen psychogenic and organic erecticle dysfunction?

A
  • 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
35
Q

Which neurotransmitters are inhibitory for arousal? (2)

A

Serotonin

Prolactin

Both are also inhibitory for libido

Repro/GU by Minnie (she/her) (31 decks)

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