Human Sexuality Exam Flashcards
common diseases associated with sexual dysfunction
depression cardiovascular disease chronic respiratory disease musculoskeletal disorders cancer
When should nitroglycerin not be taken for sexual dysfunction?
patients on sildenafil
What antidepressant negatively affect all aspects of sexual function?
venlafaxine
mirtazapine
What is required for an orgasm?
intact sympathetic NS
muscle tone
What is Erotophilia and Erotophobia referring to?
Positive or negative emotional responses to sexuality
Outercourse
Any form of sexual intimacy that does not involve intercourse
FROTTEURISM
Touching or rubbing a non-consenting person in a sexual manner or the recurrent urge to do so (like bus sexual assult)
VOYEURISM
peeping tom
dyspareunia
painful intercourse
sexual arousal disorder
Persistent or recurring absence of sexual fantasy
Lack of receptivity to sexual activity
sexual aversion disorder
fear and disgust of sex
categories of orgasmic disorders
primary: never had one
secondary
What conducts orgasms?
CNS (Spinal cord)
ACCUMBENS NUCLEUS: reward center
Vaginismus
Involuntary contraction of muscles around vaginal opening
Exam procedure for dyspareunia
monomanual exam
then bimanual and speculum
siladenafil
vasodilator for sexual dysfunction
intersexuality
individuals who do not conform to traditional male or female classification
pseudohermaphrodite
two testes or two ovaries but with ambiguous genital appearance
Woffian
male
Mullerian
female
hypospadius
opening of penis on underside
What is MIF and what is it produced by?
inhibits mullerian (female) development By Sertoli cells
Tumescence
Parasympathetic NS
path of male external genitalia differentiation
SRY –> TDF –> GONADS (Sertoli: MIH; Leydig: Testosterone) –> DHT (converted from testosterone) –> differentiation
What hormone are Sertoli cells affected by
FSH
What hormone affects Leydig cells?
LH
What cells influence Mullerian formation?
Sertoli
What does the genital tubercle develop into?
male or female glans
XX virilized
too much androgen; ovaries present
internally female, externally ambiguous
What can XX virilized be caused by?
congenital adrenal hyperplasia
from mom: adrenal tumor or excessive androgens
What is congenital adrenal hyperplasia caused by
male outside (phenotype), female inside enzyme block --> deficient cortisol production--> pituitary secretes high levels of precursors (that also leads to other hormones like testosterone) aka adrenal genital syndrome
What is the precursor of all steroid hormones?
cholesterol
need it to produce androgens, cortisol, aldosterone
What are the two forms of congenital adrenal hyperplasia
21-hydroxylase deficiency: 90%; low mineralcorticoid; MASSIVE androgens
11-hydroxylase deficiency: high mineralcorticoid and androgens
What does 21-hydroxylase deficiency cause?
high androgens, low testosterone and aldosterone
XY undervirilized
defect in testicular differentiation
5-alpha-reductase deficiency
cant convert testosterone to DHT –> minimally virilized male –> massive virilization at puberty
(think end organ failure)
XY androgen insensitivity syndrome
female outside, male inside testicular feminization syndrome testosterone receptor defect abdominal testes, no uterus, phenotypically female (think end organ failure)
XO chromosome (most common chromosomal abnormality)
turner’s syndrome
XXY
klinefelter’s syndrome
XXX
Triple X syndrome
premature ovarian failure
poor pregnancy congenital malformation
XXY
tall
severe acne
hyperactive
“super psycho male”
XO/XY
Mixed gonadal dysgenesis
XX/XY
Hermaphrodite
Classic symptoms of turner’s syndrome
short stature, abnormal facies, webbed neck
ovarian failure before birth, infertility
disruption of mitosis –> impaired growth
“knuckle, knuckle, dimple, knuckle”
Gender dysphoria
transexualism
cross gender identification
NO physical intersex
90% cause of Klinefelter’s and symptoms
older pregnancies
externally male
hypogonadism (no secondary secual characteristics)
XXY
eventual infertility
small penis, diminished hair, enlarged breast tissue
undetected in a lot
juvenile gender dysphoria
four or more of the following:
desire to be other sex
preference for cross-sex roles in play/dress
persistent fantasies about being the other sex
intense desire to participate in stereotypic games of opposite sex
strong prefer. for playmates of opposite sex
what age is transexuality fixed by?
12-18 months
difference between CAH and F to M trans
CAH: internally female, excessive androgen, look male, raised as male, male puberty
Trans: trapped in wrong body, all else female
Site of sperm production
SEMINIFEROUS TUBULES (10% semen)
Function of Sertoli cells
protect and nourish sperm
blood-testis barrier
What take places at the epididymis?
sperm maturation
store sperm at epididymis tail
Where does testicular artery come from?
off aorta in abdomen by kidney (bc testis originate in abdomen)
risks of retained abdominal testes
high temp so impaired sperm production
high risk of cancer
seminal vesicle
60% of semen
what is ejaculatory duct from?
vas deferens and seminal vesicle
What structures are combined in the prostate?
ejaculatory duct and urethra
what does prostate gland do?
30% volume of semen (fructose for sperm flagella ATP)
WHAT ARE THE THREE SECTIONS OF URETHRA
Prostatic, Membranous, & Penile (spongy)
BULBOURETHRAL GLAND (Cowper’s gland)
at base of penis
pre-ejaculate fluid: sterilized urethra before ejaculation
corpora cavernosa (two of them)
engorged with blood –> erection
corpus spongiosum
protect and guard urethra during engorgement
wrap around urethra
What physiological change needs to occur to produce erection?
needs vascular and neural
1. increase arterial blood to corpora cavernosa
2. decrease venous outflow (close off)
blood in and not out
what is tumescence mediated by?
nitric oxide
how does nitric oxide
released by Parasympathetic postganglionic cell
cause arterial inflow and block venous outflow
what is a common initial vascular disease presentation in males?
erectile dysfunction (if see this symptom, check other vascular dysfunction)
What does internal pudendal artery supply and where does it come from?
dorsal penile artery down to cavernous artery
from internal iliac a.
venous sinusoid
cavities in cavernosa –> can expand with erection and collapse when flaccid
what does the tunica albuginea do?
stretch during tumescence and pinch of venous outflow
action of PNS v. SNS in tumescence
Parasympathetic: initiate tumescence, nitric oxide, muscle relaxation (arterial dilation)
Sympathetic: ejaculation and resolution, smooth muscle contraction (arterial constriction)
bulbocavernosus muscle
muscle surrounding urethra –> clears urethra
ischiocavernosus muscle
contract during sexual excitation and ejaculation to close off vein
Nerve route of Somatic Input of tumescence
dorsal nerve –> internal pudendal n. –> bulbocavernosus and ischiocavernosus muscles
afferent stimulation v psychogenic impulse during tumescence
afferent: from touch
psychogenic: no touch
what is involved in somatic input of tumescence
afferent stimulation
psychogenic impulse
motor input
How can pts with spinal cord injury have tumescence?
reflex arc from direct touch stimulation
what are the stages of tumescence and what nerve system involved?
excitement: efferent parasymp
orgasm - emission: efferent symp
organsm - expulsion: efferent symp/somatic
resolution: efferent symp
Masters and Johnson: 2 principle physio changed
- vasocongestion
2. myotonia
4 phases of human sexual response cycle (M+J)
excitement
plateau
orgasm
resolution
what happens to testis during tumescence?
testis elevation and enlargement
What are the two stages of male orgasm?
stage 1: sense of ejaculatory inevitability bc fluid in urethra
2: ejaculation, muscle contraction
BP and pulse rises
Helen Singer-Kaplan’s triphasic model
sexual desire: psych
excitement: vascular
orgasm: muscle
Difference between MJ and Singer-Kaplan’s model***
HSK considered DESIRE***
causes of erectile disorders***
vascular: 40%
diabetes: 35%
medication: anti-HTN, anti-depressants
injury: eg prostate
most common sexual dysfunction in young men***
premature ejaculation***
priapism
failure of detumescence (>4hrs)
extremely painful erection
can lead to proprial fibrosis
What drug classes contribute to ED?***
Anti-HTN: beta blockers, diuretics Anti-cholinergic Anti-depressant Anti-psychotics Sedatives/drug abuse
Types of testosterone in blood
tightly bounded to SHBG
loosely bound to albumin (68%)
free
ED diagnostic test
measure free testosterone
What does viagra (Sildanefil) do?
prolong vasodilation (PDE5 inhibitor)
Paramesonephric duct v Mesonephric
Para = Mullerian, female Mesonephric = Wolfian, male
Kallmann’s Syndrome
hypogonadotropic hypogonadism deficient hypothalamic GnRH infertility abnormal pubertal maturation usually in males
adrenarche
increase in adrenal androgen; ~age 6
secondary sex characteristics (hair, sebaceous glands)
Pubarche
appearance of pubic hair
Gonadarche
FSH and LH activation of gonads
male: testicular enlargement
female: ovulation from LH surge
Thelarche
breast development (breast buds)
Spermarche
first ejaculation
premature thelarche
<2 yo: self limiting
>2 yo: can have uterine bleeding
precocious puberty
development of secondary sexual characteristics before 8yo –> reduce adult height
what does bone age tell you?
pubertal age
When is menarche?
one year after growth spurt
FIRST SIGN OF GROWTH SPURT IN GIRLS***
Breast buds! (sometimes pubic or axillary hair)
Female Tanner Stages (SMR)***
1: nipple elevation (preadolescence)
2: breast bud; elevation of breast and nipple as small mound
3: elevation of breast and areola (no separation of contour)
4: secondary mount from areola and nipple projection
5: mature stage; only nipple projection (areola recedes)
First sign of male puberty***
testicular enlargement
First ejaculation stage
SMR3
Male Tanner Stages***
1: no hair
2: testicular enlargement; some downy hair
3: pub hair coarse and curly at base
4: adult quality hair, NOT on thighs
5: adult quality and QUANT ON thighs
Gynecomastia
breast enlargement in boys (40-65%); resolves itself within 3yrs
Sexual orientation
ID of physical/emotional attraction to others
cisgender
someone not transgender
gender nonconforming
gender fluid (not quite at transgender level)
nonbinary
gender nonconforming individual identifies as neither male or female
transmasculine/transfeminine
directionality of gender identity of gender nonconforming individual
gender affirmation
recognizing, accepting and expressing one’s gender identity
Feminizing hormone therapy
estrogen (17-beta-estradiol)
+ androgen blocker (sprinolactone)
+/- progestagen ()
Biggest adverse effect of androgen blockers***
hyperkalemia
masculinizing hormone therapy
testosterone
side effect: acne
5 P’s of sexual history
Partners Practices Past History of STI’s Protection from STI’s Pregnancy Plans/Prevention
Screening for adolescent issues: HEEADSSS
Home environment Education, employment Eating Activities (peer-related), affect, ambitions, anger Drugs Sexuality Suicide/depression Safety from injury and violence
celibacy
refraining from intercourse bc not married (doesnt have to be virgin)
chastity
refraining from intercourse and other activities (and thoughts) bc moral purity or virtuousness
paraphilia
OVERDEPENDENCE ON CULTURALLY UNACCEPTABLE/ UNUSUAL STIMULUS FOR SEXUAL AROUSAL/ SATISFACTION
transvestic fetish
arousal from dressing like opposite sex
treatment for variant sexual behavior
DECREASING VARIANT SEXUAL AROUSAL:
AVERSIVE CONDITIONING
COVERT SENSITIZATION
INCREASE NONVARIANT SEXUAL AROUSAL:
MASTURBATORY CONDITIONING
EXPOSURE
SYSTEMATIC DESENSITIZATION
Raptophilia***
Sexual gratification from rape
Coprophilia***
Sexual gratification from defecation
