B8-069 Sexual Dysfunction & B8-079 Female Sexual Response Flashcards
5Ps of sexual history
Partners
Practices
Protection
Past hx of STI
Pregnancy intention
the genital tubercle becomes the […] in males, and […] in females
the genital tubercle becomes the [glans penis] in males, and [glans clitoris] in females
the urogenital groove becomes the […] in males, and […] in females
the urogenital groove becomes the [urethral opening] in males, and [urethral +vaginal opening] in females
the urogenital folds becomes the […] in males, and […] in females
the urogenital folds becomes the [urethra] in males, and [labia minora] in females
the lateral tubercle becomes the […] in males, and […] in females
the lateral tubercle becomes the [penile shaft] in males, and [clitoral shaft] in females
the genital swelling becomes the […] in males, and […] in females
the genital swelling becomes the [scrotum] in males, and [labia majora] in females
the glans penis continuous with the corpus […]
spongiosum
the urethra is housed in the corpus […]
spongiosum
gives rise to both the dorsal penile a. and deep penile a.
common penile a. (via internal pudendal)
artery that perfuses the glans penis
dorsal penile artery
artery that allows corporal filling during erection
deep penile (cavernosal) a.
artery that allows the corpus spongiosum to fill during erection
bulbaourethral artery
erection is a [sympathetic/parasympathetic] function
parasympathetic
detumescence is a [sympathetic/parasympathetic] function
sympathetic
emission is a [sympathetic/parasympathetic] function
sympathetic
parasympathetic function of the […] nerve is responsible for erections
pelvic splanchnics
(S2, S3, S4)
nerves surrounding the prostate that can be damaged during prostate surgeries
cavernous nerves
sympathetic function of the […] nerves are responsible for emission/detumescence
hypogastric
innervates the ischiocavernosus muscle for the rigid erection phase
internal pudendal n.
innervates the bulbospongiosus muscle for ejaculation
internal pudendal n.
what part of the brain is responsible for how we perceive sex?
cerebral cortex
what part of the brain is responsible for how we feel about sex?
amygdala
(larger in men, greater emphasis on visual stimuli)
what part of the brain is responsible for arousal?
hypothalamus (MPOA)
what neurotransmitter facilitates sexual behavior?
dopamine
(serotonin opposite effect)
refractory period where another erection can’t be achieved increases with […]
age
useful to determine psychogenic ED from physiologic ED
presence of nocturnal erection
increased sinusoidal pressure during erection leads to decreased […] outflow
venous
(this + stretched tunica albuginea =venous compression of emissary veins)
during erection, arterioles dilate allowing for increased blood flow to the
sinusoids
release of […] by the parasympathetic cavernosal nerves allows for smooth muscle relaxation –> erection
NO
(can also release ACh to stimulate epithelial cells to produce NO)
secretion of seminal components by seminal vesicles, prostate, ampulla of vas is the […] phase of ejaculation
emission
forceful propulsion of semen out of the urethra is the […] phase of ejaculation
expulsion
[…] promotes emission/ejaculation
neurotransmitter
dopamine
[…] inhibits emission/ejaculation
serotonin
muscle of the penis important for expulsion of fluid from posterior urethra
bulbospongiosus
muscle of the penis important for pushing all of the blood into the penis for the rigid erection phase just before ejaculation
ischiocavernosus muscle
low serotonin can play a role in what ejaculation disorder?
premature ejaculation
(SSRIs can help)
alpha blockers can cause what ejaculation disorder?
retrograde ejaculation
(they relax the bladder neck, tamsulosin)
medications that can cause male sexual dysfunction
anti-psychotics
beta blockers
anti-depressants
narcotics
involuntary muscle spasms around the vagina that can make penetration nearly impossible
vaginismus
golden standard of care for vaginismus
PT
psych
MD
high pelvic floor strength is related to […] orgasms
vaginal
(women with medium vaginal floor strength were only able to experience clitoral orgasms so clitoral orgasm are associated with both medium and high muscle tone)
what about the female sexual response is a consideration prior to hysterectomy?
the uterus contracts during orgasm
what hormone stimulates orgasm and inspires attachment?
oxytocin
parts of the woman’s erectile network
clitoris
perineal sponge
urethral sponge
vestibular bulbs
[…]% of women will be anorgasmic throughout their lives
10
(lack of information or understanding about anatomy/arousal are contributors)
what aspects of sexual behavior of influenced by body image?
number of partners
orgasmic response
level of arousal
ED medication that can cause vision changes due to cross-reactivity of PDE-6 in the retina
sildenafil
(switch to tadalafil)
how does chronic opioid use affect male sexual function?
GnRH suppression –> low T and FSH –> low sperm counts
which PDE 5i medication has the quickest onset?
avanafil (15 min)
high fat meal decreases the efficacy of what PDE 5i medications? [2]
sildenafil
vardenafil
which PDE 5i medication has the longest onset?
tadalafil
which PDE 5i medication has the longest duration of action?
tadalafil
which PDE 5i medication has the shortest duration of action?
avanafil
