Infertility and sexual dysfunction Flashcards
Definition of infertility
No conception after 1 year
with regular intercourse
q2-3 days
Preconception counseling
Take folic acid Stop smoking and drinking and drugs Stop teratogenic medications Control weight Do rubella, Hep B, HIV testing
Education on conception:
You should have unprotected penetrative vaginal intercourse q 2-3 days from 6 days prior to ovulation to a few days afterwards
Causes of infertility Female
PCOS
Prolactinoma
Thyroid
Cushings
PID
Adhesions
Uterine anomoly
Hostile cervical musous
Stricural issues of the cervix
Endometriosis
Causes of infertility Male:
Varicocele STI Kleinfelters TOrsion Radiation marijuana
Alcohol
Smoking
Obesity
Previous radiation
Chemo
Surgery
Mumps
Cryptochidism
Risks of fertility treatment
Blood clots
Pulmonary edema
Ovarian hyperstimulation syndrome (Abdo pain and bloating)
Workup
Pap STI testing Day 3: LH FSH prolactin estradiol testosterone Day 21 progesterone Rubella varicella
Consider DHEA if hyperandronenism is concern
Semen analysis
Consider LH FSH prolactin estradiol in men
Imaging:
Ultrasound
Hysterosalphiogram
Special tests:
Anti mullerian hormone testing (DO if >35 or risks such as previous surgery, chemo, radiation or unexplained fertility)
When to refer for fertility
generally 1 year
If >35 refer at 6 months
if >40 refer immediately
Consider earlier if history of PID, STI, amenorrhea pain
Varicocele, urogenital symptoms or any abnormal tests
History to ask for fertility
LMP Cycle regularity What tests they are doing now for ovulation GTAPL Miscarriages Previous methos of contraception Lubricants (spericidal?) Past surgeries Past chemo Past STIs medications Prenatals Family history
List two female and two male treatments for sexual dysfunction
Female: Lubrication Topical estrogen Counseling CPT Pelvic floor physio Body image counseling
Male: Testosterone Sildenafil (viagra, Phosphodiesterase inhibitor) Counseling Alprostadil (prostaglandin) can be intracaversonal injection or intraurethral pill Vacuum Penil prosthesis Also counseling etc.
History for erectile dysfunction
Contraception
Morning erections
Age of partners
expectations
Labs for erectile dysfunction
AiC
Lipids
Testosterone
Priapism- how to investigate and how to treatment
Dolpler US of the ween
Cavernosal blood gas
Non ischemic :
Watchful waiting, 5a reductase inhibitor, Gnrh agonist
Ischemic: needle drainage, intracavernosal phenylephrine, surgical shunt >48 hrs
Sex history basics
Thinks ABCSti
Abuse: domestic, if 18 exploitive, 16 if non exploitive, youth (14, can be 5 yrs, 12 can be 2 yrs).
Report
Babies: last menses, contraception, use, typed, missed, need? Emergency?
Cancer: last pap, HPV vax
STI: condoms, internal/external, previous STI, trade for sex/$
Prevent, treat, test, contacts, abstain, report
HIV pre-exposure prophylaxis PReP, who is it for and what is it called?
TRUVADA (emtricitabine/tenofivir), counsel not good for other STI’s, use condoms
Labs: STI screen, cbc, Cr, Hcg, Urinalysis Q3m plus give Hep vaccines
Recommended for :
MSM
TRans - condomless anal sex with HI/unknown
Might benefit:
IVDU
Hetero with vag/anal HIV +
decreases by 90%, use one pill per day or on demand around Intercouse
