Female/male psychosex (ED/premature ejaculation) Flashcards
4 phases of sexual response cycle?
Excitement, plateau, orgasm, resolution
Ix for erectile dysfunction?
Full medical hx inc drugs, neuro assessment, bloods for glucose, testosterone, cholesterol, U&E, LFT, prolactin, TSF (esp if <50yo and sudden onset), BP, Udip, consider USS to assess blood flow and atherosclerosis.
Which nerve system is responsible for erection?
Parasympathetic (point and shoot mnemonic)
Which nerve system is responsible for ejaculation?
Sympathetic (point and shoot mnemonic)
Causes of erectile dysfunction?
Vascular (inadequate blood supply – HTN, atherosclerosis, DM),
Nerve (trauma, surgery, stoke),
endocrine (reduced testosterone, reduced nitric oxide synthase and smooth muscle relaxation resulting in erection)
medications (thiazide, SSRI, b-blockers, antiepileptics, levodopa, LHRH analogues),
psychological
Tx for erectile dysfunction?
Lifestyle modifications, stop trigger drugs if possible, information about it, PDE-5 inhibitors, vacuum pumps, surgical implants.
1st line medical tx for erectile dysfunction?
PDE-5 inhibitors, Sildenifil
Contraindications for sildenafil?
Hypotension <90/50
unstable angina or arrhythmia
MI <90/7 ago
concomitant use of nitrate or nicorandil,
uncontrolled HTN,
hyportension on alpha blockers,
retinitis pigmentosa
serve hepatic impairment.
How long after a MI or stoke is vardenafil CI?
6/12
Risks/SE of PDE-5 inhibitors?
Hypotension, flushing, nausea, dizzy priapism, visual disturbance, hearing disturbance, myalgia
What % will PDE-5 inhibitors work in for erectile dysfunction?
80%
Prevalence of premature ejaculation?
1-3%
Definition of premature ejaculation?
<1min from entry to vagina or clinically significant time (typically <3min)
Risk factors for premature ejaculation?
Obesity, poor health, psychological ED, varicocele, sexual trauma, MS, peripheral neuropathy, thyroid disorder, drugs (dopaminergics amphetamine, cocaine) prostatitis
Mx of premature ejaculation?
Info giving, condoms or women on top, squeeze and go learning to stop just before ejaculation, psychosexual counselling, SSRI (needs to be daily) or Dapoxetine is licenced SSRI on demand, anaesthetic creams, PDE-5 inhibitors.
Hx taking for premature ejaculation?
Every time, sometimes, situational, masturbation, lifelong or new, time to ejaculation, any ED, impact on them, PMhx/medications
Dapoxetine for tx of premature ejaculation how to take?
1-3hrs before needed
Age cut of for Dapoxetine for tx of premature ejaculation?
<65 is ok, gives ~1-4mins extra
A 22 yo presents with genital pain, she was seen by a colleague 2/52 ago who examined her and could not find any abnormalities, STI screening, udip and MS&C were negative.
Skin care is good.
The pain is on touching and she find sex painful particularly on initial penetration, you suspect provoked valval pain syndrome.
What are the treatment options.
Information giving
Examine for trigger points, teach about self massage and pelvic floor relaxation/consider physio referral
Topical analgesia
Consider tricyclics (amitriptyline 10mg increasing as required), gabapentin can also be considered
Explore sexual hx, any abuse/triggers for the pain
Consider psychosexual referral.
What types of vulval pain conditions are there
provoked and unprovoked localised and generalised cliterodynia vestibulodyina vaginismus hemivulvodynia
When suspecting vulvodynia what steps in hx/exam/ix should be done
Full hx (SCORATES for pain and specific enquiry for o&g hx, traumatic birth/preg loss, dyspareunia, sexual hx inc assault/non-consensual SI)
Examine - skin, trigger points, hypooestrogenic, provoked pain
Swabs STI and MS&C
Udip if urinary sx.
Then dx of clinical suspicion and exclusion
Differnential for vulval pain
Infection (eg candida/HSV)
Inflammation (eg lichen)
Neoplasm (eg VIN)
Neurological (eg spinal damage/post HSV neuralgia)
