genitourinary - premature ejaculation, PCOS

Question 1

what is premature ejaculation

Answer 1

common male sexual disorder
brief ejaculatory latency, loss of control, psychological distress

Question 2

non drug treatment of premature ejaculation

Answer 2

includes psychosexual counselling, education and behavioural treatments
these are recommended in pt for whom PE causes few, if any, problems or in pt who prefer not to take drug treatment
they can also be used in addition to drug treatment

Question 3

what management approach is recommended for pt with life long premature ejaculation

Answer 3

drug treatment

Question 4

What is licensed to be used when required for premature ejaculation (but not continuous daily use) and what class of drugs does it belong to?

Answer 4

• dapoxetine
• short acting SSRI

Question 5

Dopextine is a short acting SSRI which is licensed to be used prn for premature ejactulation.

True or false - other SSRIs and TCAs have been widely used unlicensed as regular daily treatment.

Answer 5

True
e.g. citalopram, fluoxetine, fluvoxamine, escitalopram, paroxetine, sertraline, clomipramine

Question 6

How long after regular daily treatment with SSRIs/TCAs (unlicensed) does ejaculation delay happen?

Answer 6

Ejaculation delay may start a few days after the start of treatment, but it is more evident after 1 to 2 weeks, since receptor desensitisation requires time to occur.

Question 7

If premature ejaculation is secondary to ED, which one should you treat first

Answer 7

ED

Question 8

CI for dapoxetine

Answer 8

Hx bipolar disorder
Hx mania
Hx severe depression
Hx syncope
postural hypotension
significant cardiac disease
uncontrolled epilepsy

Question 9

dose and how to take dapoxetine for premature ejaculation in men who meet all the relevant criteria

Answer 9

initially 30mg to be taken ~1-3 hours before sexual activity
subsequent doses adjusted according to response
max 1 dose per day
max 60mg daily

Question 10

what is PCOS and who does it affect

Answer 10

one of the most common endocrine disorders affecting females of CBP

Question 11

clinical features of PCOS

Answer 11

ovulation disorders, polycystic ovarian morphology, and hyperandrogenism (with the clinical manifestations of acne, hirsutism and oligomenorrhoea)

Question 12

complications of PCOS

Answer 12

CVD
obstructive sleep apnoea
psychological disorders (anxiety, depression)
infertility
endometrial cancer
pregnant complications (gestational diabetes, pre-eclampsia)
metabolic disorders (insulin resistance, T2D)

Question 13

true or false - complication of PCOS is CVD

Answer 13

true

Question 14

1st line management PCOS

Answer 14

lifestyle modifications
healthy eating, regular physical exercise, maintaining healthy weight

if overweight or obese, offer weight loss advice or consider referral to dietician

Question 15

true or false - in pt with PCOS who are overweight or obese, encourage weight loss because it can achieve menstrual regularity and reduce insulin resistance, hyperandrogegism and the risk of T2D and CVD

Answer 15

true

Question 16

what is commonly used to treat acne, hisutism and menstrual irregularity in pt with PCOS

Answer 16

COC (unlicensed) if not planning pregnancy

Question 17

COC commonly used in PCOS for acne, hirsutism, menstrual irregularity. Alt treatment for menstrual irregularities includes … (2)

Answer 17

• cyclical progestogen unlicensed
• LVNGTL IUS (unlicensed)

Question 18

can a GP initiate treatment with insulin sensitising drugs in PCOS e.g. metformin

Answer 18

no specialist only

Question 19

when can metformin be considered in PCOS

Answer 19

impaired glucose tolerance or are already undergoing lifestyle modifications with no improvement in impaired glucose tolerance [unlicensed indication]

Question 20

what can metformin improve

Answer 20

may improve short-term insulin sensitivity and reduce androgen concentrations, but there is limited supporting evidence on the long-term benefits.

Question 21

consider the following in females with PCOS who are pregnant or considering pregnancy

Answer 21

referral for gestational diabetes screening, and whether any changes to drug treatment(s) are required.