L21 - Sexual dysfunction Flashcards
examples of sexual dysfunction problems?
low desire
arousal problems
lack of orgasm
pain during sex
define erectile dysfunction?
The persistent inability to attain and /or maintain an erection sufficient for sexual performance >3-6 months
Organic causes of erectile dysfunction ?
cardiovascular 40%
diabetes 30%
medicinal 15%
5% neuro
Aetiology and risk factors for erectile dysfunction
Lifestyle - sedentary lifestyle nicotine alcohol abuse drug addictions age
CV risk -
hypertension
dyslipidemia
CAD
Diabetes mellitus -
type 1 and 2
Endocrine factors -
hypogonadism
hyperprolactinemia
thyroid disorders
Iatrogenic - drug induced
post op
medical disorders -
liver diesease
resp disorders - sleep apnoea
what drugs have a negative impact on erectile dysfunction ?
Antihypertensives - thiazide diuretics, BB, CCB
Antidepressants/neuroleptics
SSRIs
Anti-arrhytmics
Tamsulosin
Recreational substances - Marijuana opiates cocaine nicotine alcohol
Mechanism of erection
1 - erotic stimuli
2- neural initiation
3- cellular activation
GMP mediated relaxation of smooth muscle
4 - relaxation of cavernous smooth musculature
reduce your a-sympathetic tone of cavernous muscles
increase parasympathetic tone
dilation of arterioles
corpus cavernosum fills with blood
stretching of tunica albuginea causing hard penis
5 - Erection
Nitric oxide causes erection. by dilating blood vessels
may also need genital stimulation with increasing age for contraction of pelvic floor and increases venous pressure to get rigid erection
Effect of stress on ED
STRESS = increased sympathetic tone = adenaline
which causes erectile dysfunction
Coronary artery disease and ED
Arteriosclerosis in coronary arteries relates to arteriosclerosis in penile arteries
they share the same risk factors as well as obesity, low testosterone and depression
Factors contributing to ED in diabetes?
Angiopathy - reduced blood flow
polyneuropathy - reduced sensation, motor drive
impairment of neurotransmitter synthesis/release
Endothelial and SM cell dysfunction = limited muscle relaxation and poor blood flow
Impairment of cavernous tissue architecture = limited inflow of blood and poor swelling
Lack of use causes smooth muscle apoptosis =
Reduction in length and fibrosis poor function
Therapy for ED
diabetes control
cardio-resp fitness
What is the PLISSIT model for approaching sexual health problems?
PERMISSION - to discuss sex with the patient and for pt to discuss concerns
LIMITED INFORMATION - clarify misinformation, dispel myths and provide factual information
SPECIAL SUGGESTIONS -
directly related to particular problem, practical
INTENSIVE TREATMENT
provide referral/therapy for complex issues
ED treatments
Alprostadil- Injection therapy.
Intra urethral Alprostadil – Muse
Vitaros – topical alprostadil
Vacuum pump.
Combined PDE5 and Vacuum therapy.
Therapeutic Support for individual and couple.
Lubricants
Testosterone
(Dapoxetine for PE)
Must use at least 8 X
Contraindication with PDE5-is + nitrates
Androgens for men - total testosterone below 8nmol/l
between 8-12nmol/l repeat test with prolactin
Intracavernous auto injection therapy - injection of Alprostadil into the cavernous body
Who should you NOT treat with testosterone replacement therapy?
breast cancer liver tumour severe cardiac failure untreated sleep apnoea untreated prostate cancer moderate or severe BPH
Vacuum device
use everyday
shave pubic hair at penis root
use lubricant for ring
use the smallest ring that you can tolerate
Classification of Female Sexual Dysfunction in diabetes
FEMALE AROUSAL DISORDER
because of problem with lubrication. if you have problems with your nerves or blood vessels will not get the lubrication.
FEMALE ORGASMIC DISORDER
PAIN DISORDERS -
DYSPAREUNIA - genital pain associated with sexual intercourse
VAGINISMUS - Involuntary contraction of the perineal muscles preventing vaginal penetration
What causes female sexual dysfunction?
INTERPERSONAL RELATIONSHIPS
partner performance
lack of partner
relationship quality and conflict
PHYSIOLOGICAL neurological problems CVD cancer medications Fatigue urogenital disorders
SOCIOCULTURAL INFLUENCES inadequate education conflict with religion family values societal taboos
PSYCHOLOGICAL depression anxiety prior sexual abuse stress alcohol/substance misuse
causes of inhibited desire?
fear of pregnancy medication side effects hormonal issues depression sexual phobias gender identity isssues religious beliefs lack of attraction to partner partners poor sexual skills fear of closeness and vulnerability intimacy issues
What is Atrophic Vaginitis
Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls due to your body having less estrogen.
What can atrophic vaginitis cause?
Can lead to : Avoidance of sexual relationships due to dyspareunia . Performance anxiety. Loss of sexual desire Relationship distress.
why do women become dry in atrophic vaginitis?
less vaginal folds when women get older and less lubrication
Treatments for post hysterectomy or post menopausal female sexual dysfunction
foreplay + genital stimulation to inc blood flow and lubrication
pelvic floor exercises - inc conctractions can mean better orgasms
use of a vibrator
HRT?
estradiol (vagifem) pessary 10mcgs restores vaginal mucosa
testosterone
