Lecture 24: Sexual dysfunction

Question 1

Whats the sexual response cycle?

Answer 1

Excitement
Plateau
Orgasm
Resolution

Question 2

What is the kaplan 3 phase model?

Answer 2

Desire -> Arousal -> Orgasm

Question 3

What is the non-linear female sexual response model?

Answer 3

Circular model

Different from others because not linear and acknowledges that you can go from sexual drive to sexual interaction without arousal // emotional intimacy etcetc

Question 4

What is the biggest sex organ and why?

Answer 4

The brain is the largest sex organ

Neuropsychophysiological

Question 5

What is the biopsychosocial model of sex?

Answer 5

Acknowledges that Psychological, Biological and Social roles interact when it comes to sexual being

Question 6

What are some age related changes that may influence sexual function?

Answer 6

• Menopause
• Decline in sex hormones
• Decline in labido
• Men : Less spont. erections, longer refractory period.
• Females: Tissues atrophy, more time required for psychological arousal

Question 7

What are the DSM5 categories of sexual dysfunction for men and women?

Answer 7

• Female sexual interest/arousal disorder
• Female orgasmic disorder
• Genito-pelvic pain penetration disorder (vulvodynia)
• Male hypoactive sexual desire disorder
• Erectile disorde
• delayed ejaculation
• premature ejaculation

Question 8

Whats the typical presentation for sexual dysfunction?

Answer 8

• Desire
• ORgasm
• Erection
• Pain with sex
• Penetration not possible

Question 9

What history is important to get for a sexual dysfunction patient?

Answer 9

History of presenting problem

Sexual history

• STI
• Current
• Length or relationship

History of drug or medications

• SSRIs can be assc with ED
• Some recreational drugs can be assc with ED too

Question 10

What is CBT/mindfullness therapy for sexual dysfunction patients?

Answer 10

• Builds self acceptance (gets rid of perm anxiety / worries of appearance)
• Coping with anxiety
• Reduced hypervigilence

Question 11

What is the plissit model used for intervening with sexual dysfunction?

Answer 11

P = Permission to talk about sexual matters, fantasize, enjoy sexuality
L = Limited Information
S = Specific Suggestions
I = Intensive Therapy

Question 12

What is the sensate focus - Masters and Johnson model?

Answer 12

• Designed to move away from performance goals, instead enhancing pleasure and increasing awareness of errogenous zones // sensation. Improved communication.

4 stages:

• Non-genital touch (emphasis on giver)
• Non-genital touch (emphasis on reciever)
• Genital touch
• Mutual sexual touching

Question 13

What gets in the way of sexual desire?

Answer 13

• Unrealistic expectations
• Focus on performance rather than closeness and pleasure
• Emotional isolation
• Inability to be open with our partners

Question 14

What is the management of low sexual desire?

Answer 14

• Primarily sex therapy / counselling

AS a doctor:

• Listen
• Reassurance / education
• Manage any medical issues arising or refer on appropriately
• Refer to appropriate therapist

Question 15

What are the therapeutic approaches to prem ejaculation:

Answer 15

• Squeeze
• Stop start
• Local anaesthetic
• Pharma i.e
• > SSRI
• Sex therapy

Question 16

What can cause erectile dysfunction?

Answer 16

• Organic and psychogenic
• Chronic illness, surgery, trauma
• Modifiable risk factors
• ED prevalence increases with age

Question 17

What are the psychogenic causes of ED?

Answer 17

• Due to central inhibition of the erectile mechanism without physical injury or insult
• Psychogenic component present in most cases of ED

Question 18

What are the organic and modifiable factors of ED?

Answer 18

• Fear of failure
• Chronic illness
• Peyronies

Modifiable factors

• Alcohol
• Smoking
• Medication and recreational drugs

Question 19

What is the basic management of ED?

Answer 19

• Diagnosis
• Co-morbidities
• What do the couple want? Elderly might not actually want it…
• Adjust meds
• Address lifestyle
• Education
• Tailored treatment
• Interrupt performance anxiety (MINDFULLNESS)

Question 20

What are some medical treatments for ED?

Answer 20

PDE5 Inhibitors

• Sildenafil (low cost, now generic)
• Tadalafil (Longer duration of action)
• Vardenafil (Short duration of action)

Question 21

What is vulvodynia?

Answer 21

Vulvar pain of at least 3 months duration without clear identifiable cause, which may have potential associated factors

Question 22

What causes vulvodynia?

Answer 22

• Multifactorial
• Neuropathic pain
• Triggers i.e candidiasis, trauma
• Pelvic floor dysfunction
• Psychological aspects

Question 23

What can chronic pain lead to?

Answer 23

• Central sensitisation
• Fear/avoidance
• Catastrophic thinking
• Avoidance
• Lack of self efficacy/hopelessness

Question 24

What is the treatment of vulvodynia?

Answer 24

General

• Sexual health/gynaecology, physiotherapy, counselling / sex therapy
• Includes sexual partner but unsure patient is also seenn on her own
• Education
• Sensate focus
• Relaxation

Question 25

What is the treatment of vulvodynia?

Answer 25

• Therapy / drugs for neuropathic pain
• Surgery (only for LPV)
• Pelvic floor physiotherapy
• Counselling

Question 26

What is apareunia?

Answer 26

• Inability to achieve penetrative sex
• Fear
• Primary LPV
• Anatomical abnormalities