Chronic Complaints Flashcards
Sexual Dysfunction
The sexual response is divided into four phases:
The first is libido (or desire/interest). This phase requires androgens and an intact sensory system.
The second phase is arousal (or excitement) and in men, involves erection.
Hypoactive sexual desire disorder is
something experienced by 15% of men and 33% of women for at least 1 of the past 12 months. Most commonly, this is a result of relationship problems, but a growing body of evidence does suggest androgen deficiency may play a role in some women.
Sexual aversion disorder is an extreme aversion to and avoidance of genital contact with a sexual partner.
Sexual arousal disorder refers to the inability to maintain an adequate physiologic sexual excitement response.
Vascular arterial or inflow problems are by far the most common cause, though mood disorders, stressors, and alcohol abuse may all play a role.
Dx: In men with erectile disorders, obtaining a morning serum-free testosterone is appropriate. If the level is low, the workup
should continue before testosterone replacement is considered. The next step is to obtain a FSH, LH, and prolactin level. If the FSH and LH are low, but the prolactin
is normal, the diagnosis is pituitary or hypothalamic failure. If the FSH and LH are high and the prolactin is normal, the diagnosis is testicular failure. If the FSH and
LH are low, but the prolactin is high, there is up to a 40% chance that the patient has a pituitary adenoma and a CT or M RI should be ordered
Tx: Fluoxetine raises the threshold for orgasm, making it an effective treatment option for premature ejaculation.
The most effective treatment program found to date for women with primary organsic dysfunction is directed self-stimulation.
