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Sexual Health > Disorders > Flashcards

Disorders Flashcards

1
Q

What is hypoactive sexual desire disorder (HSDD) ?

A

Where a person loses their desire to have sex, which includes a decrease in fantasies.

Loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not preclude sexual enjoyment or arousal but makes the initiation of sexual activity less likely.

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2
Q

What are the physical causes of HSDD?

A

High prolactin, Hypogonadism, Androgen deficiency, Anti-depressants and psychotics, orchidectomy, Hypothyroidism, Addison’s, Post pregnancy, OCP, HRT, Tamoxifen, Beta blockers, oophorectomy, obesity, CVD, DM, anaemia, tiredness, low mood, sleep problems, low concentration

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3
Q

Why do OCP, HRT and tamoxifen impact on desire?

A

they bind to testosterone

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4
Q

What are the psycholocial causes of HSDD?

A

mental health problems, stress, trauma or abuse, body dysmorphia, erotic dissatisfaction, relationship problems

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5
Q

What investigations do you do for HSDD?

A 
FBC 
Oestrogen and testosterone 
Prolactin 
Glucose and lipid ratio 
TSH 
SHBG (Sex hormone-binding globulin), albumin ----> hypogonadism
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6
Q

What is the management for HSDD?

A

CBT
Psychodynamic therapies
Couple therapies
Sex education
Testosterone treatment – injection, patches, buccal or S/C
Therapies work on communication, normalisation, lessen performance anxiety and change unhelpful attitudes

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7
Q

What is the definition of erectile disorder?

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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8
Q

What is the cause of erectile disorder?

A

Medical condition – CVD, DM, neuro eg MS
Hormones- androgen deficiency, hyperprolactinaemia
Iatrogenic- post prostate surgery, SSRIs or anti hypertensives
Age
Ineffective stimulus
Pain
Veno occlusive disorder
Mental health problems
Performance anxiety
Relationship problems

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9
Q

What is the management for ED?

A

PO: sildenafil, avanafil, tadalafil, vardenafil
Intra cavernousal injection: alprostadil
Intraurethral injection: alprostadil
Vacuum device, penile-scrotal rings
Kegel exercises

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10
Q

what is female sexual arousal disorder

A

Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:

  1. Absent/reduced interest in sexual activity
  2. Absent/reduced sexual fantasies
  3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
  4. Absent/reduced sexual excitement during sexual activity
  5. Absent/reduced sexual interest/arousal in response to any sexual cues
  6. Absent/reduced genital or non-genital sensations during sexual activity
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11
Q

What are the physical causes of female sexual arousal disorder?

A

Medical: CVD, DM, neuro, connective tissue disorders, ME
Hormones: oestrogen low eg post menopause or thyroid disorders
Iatrogenic: antidepressants etc
Lactation
Irritants or douching

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12
Q

What are the psychological causes of female sexual arousal disorder?

A

mental health problems, abuse, decreased intimacy, relationship problems

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13
Q

What is the management of female sexual aroual disorder?

A

Lubricants

Sensate focus - A staged programme of exercises to enable the couple to identify own and others sexual likes/dislikes and explore new techniques etc. Work with therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour
Use of sex toys
Clitoral vacuum- low evidence
Psychotherapy

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14
Q

What is female orgasmic disorder?

A

Orgasm either does not occur or is markedly delayed or marked decrease in intensity.

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15
Q

What are the physical causes of female orgasmic disorder?

A 
Medical- CVD, DM, neuro, renal/liver problems 
Androgen insufficiency, hypothyroidism 
pelvic floor damage!! 
Ageing 
SSRIs
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16
Q

What are the psychological causes of female orgasmic disorder?

A 
Mental health problems 
Abuse 
Couple script problems 
Religion 
Stress 
Relationship problems
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17
Q

What is rapid /premature ejaculation?

A

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration/ other forms of sexual activities and before the person wishes it.

18
Q

What are the physical causes of premature ejaculation?

A 
Hypersensitivity of penis 
Hyperthyroidism 
Prostatitis 
Comorbid sexual problem eg ED 
Amphetamines/MDMA/cocaine
19
Q

What are psychological causes of premature ejaculation?

A 
anxious 
Early learned experiences 
Lack of sexual activity 
Relationship problems 
Pain
20
Q

What is the management of premature ejaculation?

A

DRE prostate exam
Anaesthetic locally applied eg spray or in condoms
SSRI eg dapoxetine
Couples’ therapy
Behavioural techniques- stop and squeeze, kegel exercises, mindfulness

21
Q

What is delayed ejaculation?

A

On almost or all occasions (75-100%) either generalised or situational, without the individual desiring delay:

Marked delay in ejaculation or absence of ejaculation

22
Q

What are physical causes of delayed ejaculation?

A 
Congenital disorders 
Trauma or surgery 
age 
Infections 
Neurological eg DM, spine injury, alcohol neuropathy 
Depression 
SSRIs, thiazides, alpha blockers 
Low testosterone
23
Q

What are psychological causes of delayed ejaculation?

A

insufficient stimulation, masturbation technique, abuse, poor body image, relationship and partner issues, pain disorder

24
Q

What must you exclude in delayed ejaculation?

A

retrograde ejaculation

25
Q

What is retrograde ejaculation?

A

where ejaculation goes back into bladder, urine may be cloudy

26
Q

What investigations do you do for retrograde ejaculation?

A

Examination or testes, epididymis, vasa and prostate
FBC
Glucose
Testosterone
B12 and folate
PSA
Urine sample for spermatozoa and fructose for retrograde ejaculation

27
Q

What is the management for retrograde ejaculation?

A 
Therapy 
Couples therapy 
Kegel exercises 
Vibration stimulation 
PSGP
28
Q

What is inhibited ejaculation?

A

Same thing as delayed ejaculation

29
Q

What is vaginismus?

A

Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry or other types of penetration is either impossible or painful.

30
Q

What are physical causes of vaginismus?

A

Medical conditions causing vulva soreness eg thrush
Pain conditions
FGM
Congenital problems

31
Q

What are psychological causes of vaginismus?

A 
Religion 
Fear of pregnancy 
Previous abuse 
Unpleasant sexual experience or exam 
Fear partner 
Relationship problems
32
Q

What is the management of vaginismus?

A 
Psychosexual therapy 
CBT 
Vaginal trainers 
Relaxation techniques 
Explore self 
Kegel exercises
33
Q

What is dyspareunia?

A

Dyspareunia (or pain during intercourse) occurs in both women and men. It can often be attributed to local pathology and should then be properly categorised under the pathological condition. This category is to be used only if there is no primary nonorganic sexual dysfunction (e.g. Vaginismus or vaginal dryness)

34
Q

What are the physical causes of dyspareunia?

A

Infection
Injury
Hypersensitivity
Lesions
Introitus (pain on entry) - circumcision, recurrent infection, herpes, allergy, lichen sclerosis, cystitis, Bartholin’s cyst, urethritis, menopause, post-radiotherapy, penis size
Vaginal dryness
Mid-deep vaginal pain: endometriosis, tumours, adhesions, constipation, IBS

35
Q

What are the psychological causes of dyspareunia?

A

Previous pain or abuse
Insufficient relaxation
Poor technique of partner
Anger at partner

36
Q

What is the management of dyspareunia?

A

treat cause
Examination- steroids
Couple therapy
Sensate focus

37
Q

What is vulvodynia?

A

pain around vulva

38
Q

What is Peyronie’s disease

A

Where scar tissue inside penis causes a painful erection

39
Q

What is azoospermia?

A

absence of sperm in ejaculate

40
Q

What is hypospadias?

A

occurs at birth, when opening in urethral meatus doesn’t open at top and so don’t ejaculate out of expected place

41
Q

What is anejaculation?

A

inability to ejaculate without or with orgasm

Sexual Health (5 decks)

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