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Block 8 > ALS:Physiology of sex and the sexual response > Flashcards

ALS:Physiology of sex and the sexual response Flashcards

1
Q

sex resonpse 1 what is desire

4things

A

Desire: spontaneous sexual interest
sexual thoughts
erotic fantasies
daydreams

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2
Q

sex response 1: what is libido

A

Libido = sex drive

desire for sexual activity

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3
Q

sex response 1: what are the triggers for the sexual response 1
8points

A 
Triggers
Sight
Sound
Smell
Touch
Taste
Fantasy
Memory
Movement
… the Brain!
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4
Q

sex response 1: what is sexual response 1 ffected by

3points

A

Societal and cultural values

Thoughts, feelings and experiences (psychosexual medicine)

Value judgements – a perception of good or bad

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5
Q

sex response 2 what is arousal

what are the male and femle difference 4

A

The body’s physical response to desire.
Male/female differences
Women take longer than men to achieve full arousal.
Age differences
Can last minutes to hours
Can be lost and regained without progression

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6
Q

sexual response 2 disire women seul and mf 1 4

A 
Women can achieve arousal without desire
Both sexes
Raised BP, pulse, respiratory rate
Flushing
Nipple erection
Genital and pelvic vascular engorgement
Muscle contraction
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7
Q

sex response 2 femle

A 
Enlargement of breasts
Erection of nipples
Vasocongestion of the vaginal walls
Vaginal lubrication *
Elongates and widens
Tumescence and erection of clitoris and labia
Elevation of the cervix and uterus
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8
Q

sex response 2 male

A

Penis erects *
Scrotum thickens and testes rise
Sexual arousal does not always result in an erection
Erection can occur during sleep

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9
Q

sexual response 3 plateau

A

Plateau; period of sexual excitement prior to orgasm.
May be achieved, lost and gained without orgasm.
Increased HR, BP, flushing, RR, muscle tension.
Sense of impending orgasm.
Can last up to 3 minutes

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10
Q

sexual response 3 male

A 
Urethral sphincter contracts to prevent 
urine mixing with semen
retrograde ejaculation
Pre-ejaculatory fluid (Cowper’s gland) – presence of sperm is variable
Rising testes
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11
Q

sexual response 3 female

A 
‘Orgasmic platform’
Bartholin’s secretions increases
Continuing changes
Uterus
Labia
Areola and nipples 
Clitoris sensitive and withdraws
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12
Q

sexual response 4 organsm

A 
Orgasm; conclusion of plateau phase; release of sexual tension and  endorphins. 
Quick cycles of muscle contractions
Euphoric sensation
Peak resps, BP, PR, tension, flush. 
Changes with age
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13
Q

sexual response 4 male

A

Usually associated with ejaculation
single via resolution
3-6 contractions of the urethra, pelvic floor and anus

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14
Q

sexual response 4 female

A

multiple to & from plateau
5-12 contractions of muscles of uterus, vagina, anus and pelvic floor
Increased vaginal secretions

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15
Q

sexual response 5 resolution

A 
Resolution; relaxation. Men have a (compulsory) refractory period.
PR, BP falls
Relaxation and drowsiness
Age effect on refractory period
Now seen on MRI
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16
Q

sexual response 5 male

A

Nipples and penis soften
Scrotum relaxes
Testes drop

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17
Q

where is the G spot

A

on the anterior wlall of the vagina about half way in the vagina

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18
Q

sexual response 5 female

A

Blood vessels dilate
Pelvic organs drain
Cervix opens and drops into vagina (closes after 30 min).

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19
Q

Women’s brains have alternative pathways for sexual pleasure where do they happen. What are the two pathways

A

Alone

With a partner

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20
Q

who uses their brans less and whose orgasms are shorter

A

males

21
Q

effects of aging on males

A

delayed and less firm erections
longer excitement stage and interval to ejaculation
more direct stimulation to achieve erection
shorter plateau to ejaculation with smaller volume
longer refractory period.
Sildenafil??

22
Q

effects of aging on females

A 
reduced lubrication
reduced vascular engorgement
reduced muscle tension
reduced libido. 
HRT??
23
Q

common difficulties and assumptions of consultawtion

A

embarrassment
lack of language to describe emotions/sensations/body parts
peer pressure
assumption of another’s experience (or otherwise)
what is ‘normal’
That experience is with a partner,
and of the opposite gender
and that orgasm is a good experience
easy to be distracted by own experiences/ emotions

24
Q

what parts of the brain control orgasm

A

30 parts including prefontal cortex

25
Q

what is needed for gratification and fulfilment

A

Penetration not necessary

all 5 phases not necessary

orgasm varies in intensity; from spasm and loss of control to relaxation

Some women don’t orgasm

26
Q

what are the sexual practices

A

Be aware of cultural/subcultural norms. Very open to value judgements.
Penetration…of where? (if where)
By whom or what?
Education of what is safer sex unhealthy sex?
What are the implications for STIs eg resistant gnorrhoea?
contraception?
other health issues?
The Law?
Violence?(excitement)
Payment?

27
Q

what are the different attitudes values and biases

A 
Different sex
same sex
group sex
paid sex
public sex
married
unmarried older
age differentials
strangers
cross cultures
28
Q

what is the gmcs opion on the attidues values and biases

A

If you can’t handle it impartially, find someone who can. (GMC)

29
Q

what is is sex like in the LGBT community

A 
Diversity among orientations
erotic and emotional attractions
complex interrelations
Multiple influences
sociocultural factors
Interpersonal
experiential 
Open mind and open questions
Research guided by popular conceptions and attitudes
30
Q

what are the factors for sexual dysfunction

A

Lifelong

Acquired

Situational

could Generalised

31
Q

what are the types of physical or psychological sexual disorders

A 
Hypoactive sexual desire disorder
Sexual aversion disorder
Female sexual arousal disorder
Male erectile disorder
Female orgasmic disorder
Male orgasmic disorder
Premature ejaculation
Dyspareunia
Vaginismus
32
Q

how can sexual dysfunction occur

A 
Additional DSM sexual disorders that are not sexual dysfunctions
Paraphilias 
PTSD
genital mutilation
childhood sexual abuse
33
Q

what are the way peole present with sexual dysfunction

A

‘cant have sex’ – ‘it’s too painful’

Low libido – no interest

34
Q

what is hypoactive sexual desire

A

a lack or absence of sexual fantasies and desire for sexual activity
More common in women.
Causes clinically significant distress/impairment
The client’s big hope is androgens/pills
… our big reliance is ‘sex therapist’: assess, formulate, counselling (with education and homework)

35
Q

what are the three types of Hypoactive sexual desire

A

Lifelong/generalized: Little or no desire for sexual stimulation (with a partner or alone) and never had.
Acquired/situational: Previously sexually interested in his present partner but now lacks sexual interest in them but has desire for sexual stimulation (i.e. alone or with someone other than his present partner.)
Acquired/generalized: Previously had sexual interest in his present partner, but lacks interest in sexual activity, partnered or solitary

36
Q

Hypoactive sexual desire or Sexual Interest/Arousal Disorder

A

Lifelong or acquired
Generalized or situational
Partner factors (partner’s sexual problems, partner’s health status)
Relationship factors (e.g., poor communication, relationship discord, discrepancies in desire for sexual activity)
Individual vulnerability factors (e.g., depression or anxiety, poor body image, history of abuse experience)
Cultural/religious factors (e.g., inhibitions related to prohibitions against sexual activity)
Medical factors (e.g., illness/medications)

37
Q

what are the causual factors in sexual dysfunction

A 
Predisposing Factors
Restrictive upbringing
Disturbed family relations
Traumatic early sexual experiences
Poor sex Education
Precipitants
Relationship discord
Random failure
Infidelity
Partner dysfunction
Depression
Anxiety
Traumatic sexual experience
Ageing
Maintaining Factors
Performance anxiety
Fear of failure
Partner demands
Poor communication
Guilt
Loss of attraction
Depression
38
Q

Sexual dysfunction; physical superficial

A 
Infection
Allergy
injury (epis., irrad)
‘vulvodynia’ 
unknown
39
Q

Sexual dysfunction; physical deep

A 
Infection
Inflammation
Tumour
Post surgical
Bladder and bowel
Post sexual abuse
Treat the cause if found
‘red herrings’
team approach
40
Q

what are vaginismus

A

cannot achieve penetration due to muscle spasm.

Abuse/anxiety/ pain leading to phobia.

Negative control.

Rx= Cognitive BT commonly.

May benefit from ‘trainers’.

41
Q

what is female anorgasmia

A

Persistent or recurrent delay in or absence of orgasm (by any stimulation.)
Anger
Fear of loss of control
Poor technique
Hangups due to upbringing e.g. religion
Unmet physical and emotional needs
Management; Education, myths, relationships
For some women, just the way it always is!

42
Q

what is premature ejaculation

A

Ejaculation before wished, recurrently
Usually younger men
‘performance anxiety’
Specialist care, often in a multidisciplinary team; psychological and drug treatment.

43
Q

what is male orgasmic disorder

A 
delay or absence of orgasm/ejaculation, persistently (not retrograde ejaculation)
Causes 
Sexual trauma
Hostility
overcontrol (religion again)
lack of trust
Psychological management
44
Q

what is NATSAL

A

national sexual lifestype.

there arr more people

45
Q

what is erectile dysfunction

A

Inability to attain or retain an erection until completion of sexual activity.
Causes; physical, psychological, mixed reasons.
Multifactorial; drugs, alcohol, HIV, CVD, spinal cord lesions.
Management
Sensitive full social and sexual history as well as general history
Physical exam and workup
Injections, pellets, prostheses, pumps, psychological therapy. (Note CVD link)

46
Q

what are the conditions and treatments of same

A 
Diabetes
coronary artery disease
renal failure
CVA
arthritis
prostatic disease
poor hygiene 
Mental health problems
hormone deficiencies/ imbalance
47
Q

what is FGM

A

“All procedures which involve removal of or any other injury to the female external genitalia, for non-therapeutic reasons”
Is a crime – violence against women and girls
Classification - Types 1, 2 ,3 and 4
Has short and long term adverse health effects
Management – clinical, safeguarding
Mandatory reporting

48
Q

how do we get unconditioned or learned expressions of sexual wanting, liking and inhibition

A

the brain integrates sensory sexual stimuli with the internal state

Block 8 (2 decks)

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