Gynae 3 - Urogynae and sexual health Flashcards by Lucy Searle

What is overactive bladder syndrome?

Urgency with or without urge incontinence

Frequency and nocturia

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What is the commonest cause of overactive bladder syndrome?

Detrusor overactivity

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What are the required investigations in overactive bladder syndrome?

Urine culture to exclude infection
Frequency/volume chart
Urodynamics

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What is seen with urodynamic investigation in overactive bladder syndrome?

Involuntary detrusor contraction during the filling phase

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What is conservative management of OBS?

Decrease liquids
Avoid caffeine
Bladder re-training (first line) - suppress urinary urge and extend interval between voidings

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What is the pharmacological management of OBS?

Oxybutyin or tolterodine (anticholinergic drugs)

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What is a utero-vaginal prolapse?

Protrusion of the uterus and/or vagina beyond normal anatomical confines

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What is a urethrocele?

Prolapse of lower anterior vaginal wall, involving urethra

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What is a cystocele/cysto-urethrocele?

Prolapse of upper anterior vaginal wall involving bladder +/- urethra

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What is the name for a prolapse of the uterus, cervix, and upper vagina?

Apical prolapse

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What is an enterocele?

Prolapse of the upper posterior wall of the vagina

Resulting pouch contains loops of bowel

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What is a rectocele?

Prolapse of the lower posterior wall of the vagina, involving the anterior wall of the rectum

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What is procidentia?

Grade 3 utero-vaginal prolapse - pouch extends beyond the introitus

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What are the main symptoms of utero-vaginal prolapse?

Dragging sensation/pain/backache
Urinary changes
Constipation
Symptoms worse with prolonged standing

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How is utero-vaginal prolapse investigated?

USS
Urodynamics if urinary changes
Modified oxford system for pelvic floor muscle strength

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What are the risk factors of utero-vaginal prolapse?

Prolonged labour
Chronic cough/constipation
Non-compliance of post natal pelvic floor exercises

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What is surgical management of utero-vaginal prolapse?

Anterior compartment defect: anterior colporrhaphy

Posterior compartment defect: posterior colpoperineorrhaphy

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What is first line and second line treatment of utero-vaginal prolapse?

Pelvic floor muscle exercises

Vaginal pessary and oestrogen cream (ring pessary if sexually active)

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What is stress urinary incontinence?

The involuntary leakage of urine on effort or exertion, sneezing, coughing

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What is the most common risk factor for SUI?

Childbirth denervates the pelvic floor

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How is SUI demonstrated?

Ask patient to cough

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What are the investigations needed in SUI?

Midstream urine sample
Frequency/volume chart - normal
Urodynamic studies confirms

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What is first line treatment of SUI?

3 months pelvic floor muscle training

What is pharmacological treatment of SUI?

Duloxetine not offered anymore

What is surgical management of SUI?

Open colposuspension

What is the treatment of urge incontinence?

Bladder re-training | Oxybutynin

What is overflow incontinence?

Bladder becomes large and flaccid with little or no detrusor tone Bladder leaks when full

How is overflow incontinence diagnosed?

Urinary residual is more than 50% bladder capacity | Bladder palpable after urination

Give three physical causes of sexual health disorders

Chronic disease - CV disease, diabetes Hormone - thyroid dysfunction, hyperprolactinaemia Local - infections, irritations, endometriosis

Give three psychosocial causes of sexual health disorders

Stress/depression/anxiety Low self esteem Past trauma or abuse

Give three iatrogenic causes of sexual health disorders

SSRIs Antihypertensives (BB -ED; Alpha-blockers - retrograde ejaculation) Local damage from prostate surgery

What is sexual aversion disorder?

Complete distaste/fear of sex Discussion is distressing Generally psychological, treated with psychosexual therapy

What is hypoactive sexual desire disorder?

Lack of libido | Treat cause

Give three causes of erectile dysfunction

Diabetes mellitus/CVD Low testosterone SSRIs Prostate surgery

Give an example of non-medical treatment of erectile dysfunction

Vacuum device/penile ring

What is the medical treatment of erectile dysfunction?

Sildenafil, tardalafil, vardenafil/injectable alprostadil | Need stimulation to work

What are the features of female sexual arousal disorder?

``` Little interest in/thought about sex Decreased initiation of sex Little pleasure during sex Little physiological response to sex Decreased interest in sex when exposed to erotic stimuli (need at least 3) ```

What are three causes of female sexual arousal disorder?

SSRIs Psychological Oestrogen deficiency

What are three physical causes of rapid ejaculation

Hyperthyroidism Prostatitis ED

What are three psychological causes of rapid ejaculation?

Lack of experience Anxiety Time-pressure

What is the treatment of rapid ejaculation?

Local anaesthetic Psychosexual therapy Behavioural techniques- stop start

What are the causes of delayed ejaculation?

SSRIs Neuropathy/spinal injury Pressure

What are three causes of dyspareunia/vaginismus?

Infection Endometriosis Insufficient lubrication Trauma or abuse

What is vaginismus?

Involuntary contraction of the lower 1/3 of vaginal muscle, leading to difficult/painful penetration

What is the management of vaginismus?

Psychosexual therapy | Behavioural therapies - guided self exploration, vaginal dilators, sensate focus

What are three types of psychosexual therapy?

CBT Psychodynamic therapy Systemic therapy looks at the problem as a whole Integrative therapy - multiple treatment types

What are the 5 key principles of couples therapy?

``` Improve communication Modify dysfunctional behaviour Decrease emotional avoidance Change view of relationships Promote strengths ```

What are the principles of an asymptomatic screen in GUM clinic?

First void urine for NAAT (chlamydia/gonorrhoea) HIV and syphilis blood tests HepB/HepC serology for high risk

Which groups are considered high-risk for HepB/HepC?

IVDUs Sex workers MSMs

When is a symptomatic screen appropriate in GUM clinic?

Present with discharge/dysuria

Outline a symptomatic screen in GUM clinic

High vaginal swab Urethral swab Pharyngeal and rectal swab depending on exposures Urinanalysis

What is primary prevention in GUM?

Education and awareness Hep B vaccination Free condoms

What is secondary prevention in GUM?

Target screening | Contact tracing

What is tertiary prevent in GUM?

Treat the disease

What is the general treatment of pre-menstrual syndrome?

Regulate carbohydrate intake, reduce saturated fats and caffeine, and reduce salt intake

What is the treatment of PMS/PDD?

Continuous COCP SSRIs CBT

What is the treatment of a vaginal vault prolapse?

Sacrocolpoplexy