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GU > Lecture 24: Sexual Function and Dysfunction > Flashcards

Lecture 24: Sexual Function and Dysfunction Flashcards

1
Q

What are the two broad categories of Sexual problems

A
  1. Impairments to physiology ie: sexual dysfunction
  2. Impairments in the human relations part of the sexual experiance ie: diffiulties/consequences of the ways people conduct themselves sexually
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2
Q

What types of non-physiological sexual dysfunction is there?

A

Psychological:

  • interpsychic- relationships, communication
  • Intrapsychic- beliefs, meanings, conflicts, guilt, shame, information distortion, past sexual trauma, depression/anxiety

Social:

  • Situational
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3
Q

Whats the PLISSIT model?

A

Developed as a solution for sexual counselling.

Suggests interventions for some common sexual dysfunctions.

4 levels of complexity:

Permission to talk about sexual matters, fantasize

Limited Information

Specific Suggestions

Intensive Therapy

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4
Q

Female Sexual Dysfunction

A

Sexual interest/aurosal disorder: low desire the most common complaint.

Female orgasmic disorder
Genito-pelvix pain/penetration disorder

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5
Q

Associated factors of female + male sexual dysfunction

A
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6
Q

Treatment of FSD

A

Is there really a problem? Who’s problem is it?

Education

  • *Counselling**:
  • patient/couple
  • sensate focus

Manage medical issues: menopause, hormone replacement therapy, physiotherapy

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7
Q

Male Sexual Dysfunction

A
  • Male hypoactive sexual desire disorder
  • Delayed ejaculation
  • Erectile Disorder
  • Premature ejaculation
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8
Q

Low libido in men

A
  • Psychological: fatigue, situational factors, depression
  • Physical: hypothyroidism, hypogonadism (low testosterone), PADAM
  • Other: medication
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9
Q

Biomedical mechanisms in getting an erection

A
  • NO is released increasing cGMP in certain areas in penis
  • cGMP causes smooth muscle relaxation and arteriole expansion = erection
  • PDE 5 enzyme destroys cGMP
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10
Q

Anatomy of a flaccid penis

A

During erection these arteries (helecine and cavernossus) swell and compress the veins

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11
Q

Definition of Erectile Dysfunction

A

Persistant inability for at least 3 months, to obtain/maintain an erection sufficient for satisfactory sexual performance

-Increases with age

Organic vs psychogenic

-Chronic illness, surgery, trauma

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12
Q

What percentage of men age 40-70yrs experiance ED?

A

~52%

only around 10% full impotence

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13
Q

What is the Cause of Erectile Dysfunction

A

Organic: vascular, neurological, hormonal issues

Psychogenic: usually secondary

Can be a combo of both

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14
Q

How can prostate surgery be an issue?

A

Can damage many vessels/nerves → erectile dysfunction

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15
Q

What types of surgery can lead to erectile dysfunction?

A

Spinal cord injury

Pelvic injury/surgery

Prostatectomy

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16
Q

Modifiable factors of Erectile Dysfunction

A
  • Alcohol consumption
  • Cigarette smoking
  • Drugs: anti-hypertensives, anti-depressants, hormones, tranquelizers etc

These can be controlled by the patient!

17
Q

Basic Management of ED

A

Diagnose the issue
Evaluate co-morbidities: heart disease, vascular disease, depression
What does the couple want?
Adjust meds
Address lifestyle
Education
Tailored treatment

18
Q

Why/how is a lot ofthe psygoneic issues secondary?

A

Something goes wrong → loss of confidence →lack of interest → performance anxiety → sexual dysfunction/ actual issues during the sexual experiance

  • mindfulness approach is useful as component of trearment
19
Q

Non-invasive options for Erectile Dysfunction treatment

A
  • eliminate modifiable risk factors
  • Counselling and/or psychotherapy
  • medication
  • vacuum constriction devices
20
Q

Invasive therapy trreatments for ED

A
  • Transurethtral drug application
  • Intracavernous injection therapy
  • Prosthesis implantation
  • Venous/arterial surgery
21
Q

Phosphodiestarase 5 inhibitors (PDE5) used are?

A
  1. Sildenafil: ‘viagra’
  2. Tadalafil: ‘Cialis’ longer duration of action, option of low dose (5mg) daily, (maintains oxygenation thus improving endothelial smooth muscle health)
  3. Vardenafil: ‘Levitra’, shorter duration of action
22
Q

Other drug/physical approaches to ED treatment?

A
  • Alprostadil injected into c.cavernosa
  • ED shock wave theray
  • Vacuum device
  • Surgery

These can lead onto other issues!

23
Q

What is rapid (premature) ejaculation?

A

When ejaculation occurs before the individual wants it to (subjective)

24
Q

What are the traditional theories and responses to rapid/premature ejaculation

A

Traditional Theories:

  • furvitive early masterbation
  • too exciting vagina
  • Genital hypersensitivity
  • lack of alarm signal

Traditional therapeutic responses

  • sensate focus with ‘squeeze’ technique
  • Stop-start technique
  • local anathestic spray

not that legit

25
Q

Neurobiological approach to erectile dysfuntion

A

Selective serotonin reuptake inhibitors (SSRIs) which are antidepressants (increase serotonin levels) have proven to cause delayed ejaculation.

found via experimental evidence of

  • decreased serotonin neurotransmission
  • hypo function of 5-HT2c receptors
  • Familial aspects

By flooding the underfunctioning receptors with serotonin via SSRIs daily

26
Q

Drug treatment for premature ejaculation

A
  • Dapoxetine (priligyTM) 30mg or 60mg: main drug on the market, quickly metabolised!
  • SSRI’s daily or clomipramine daily or 12 hours before sex
27
Q

Delayed (retarded) ejaculation

A

Definition unclear.

Generalised or situational

Lifelong DE relatively uncommon (1.5 per 1000 or 3-4%)

Attributed to fear, anxiety, hostility and relationship difficulties

Contemporary theory: Waldinger’s Ejaculation Distribution Theory (EDT), bell curve

28
Q

Causes of Delayed Ejaculation

A
  1. Hypofunction of 5-HT1A receptors
    - and/or hyperfunction of 5-HT2c receptors
    - Treament research into 5-HT1A receptor agonists
  2. Acquired DE
    - Psychological
    - Some disease states: neurological condition
    - Meds: SSRIs, tricyclic ADs, antipsychotics
29
Q

Criteria that mus be met for classification?

A
  • Must be 75-100% of the time
  • minimum duration of ~6months
  • cause significant stress

Lifelong vs acquired
Severity scale

GU (28 decks)

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