Lecture 24: Sexual Function and Dysfunction Flashcards
What are the two broad categories of Sexual problems
- Impairments to physiology ie: sexual dysfunction
- Impairments in the human relations part of the sexual experiance ie: diffiulties/consequences of the ways people conduct themselves sexually
What types of non-physiological sexual dysfunction is there?
Psychological:
- interpsychic- relationships, communication
- Intrapsychic- beliefs, meanings, conflicts, guilt, shame, information distortion, past sexual trauma, depression/anxiety
Social:
- Situational
Whats the PLISSIT model?
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
Female Sexual Dysfunction
Sexual interest/aurosal disorder: low desire the most common complaint.
Female orgasmic disorder
Genito-pelvix pain/penetration disorder
Associated factors of female + male sexual dysfunction
Treatment of FSD
Is there really a problem? Who’s problem is it?
Education
- *Counselling**:
- patient/couple
- sensate focus
Manage medical issues: menopause, hormone replacement therapy, physiotherapy
Male Sexual Dysfunction
- Male hypoactive sexual desire disorder
- Delayed ejaculation
- Erectile Disorder
- Premature ejaculation
Low libido in men
- Psychological: fatigue, situational factors, depression
- Physical: hypothyroidism, hypogonadism (low testosterone), PADAM
- Other: medication
Biomedical mechanisms in getting an erection
- NO is released increasing cGMP in certain areas in penis
- cGMP causes smooth muscle relaxation and arteriole expansion = erection
- PDE 5 enzyme destroys cGMP
Anatomy of a flaccid penis
During erection these arteries (helecine and cavernossus) swell and compress the veins
Definition of Erectile Dysfunction
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
What percentage of men age 40-70yrs experiance ED?
~52%
only around 10% full impotence
What is the Cause of Erectile Dysfunction
Organic: vascular, neurological, hormonal issues
Psychogenic: usually secondary
Can be a combo of both
How can prostate surgery be an issue?
Can damage many vessels/nerves → erectile dysfunction
What types of surgery can lead to erectile dysfunction?
Spinal cord injury
Pelvic injury/surgery
Prostatectomy
Modifiable factors of Erectile Dysfunction
- Alcohol consumption
- Cigarette smoking
- Drugs: anti-hypertensives, anti-depressants, hormones, tranquelizers etc
These can be controlled by the patient!
Basic Management of ED
Diagnose the issue
Evaluate co-morbidities: heart disease, vascular disease, depression
What does the couple want?
Adjust meds
Address lifestyle
Education
Tailored treatment
Why/how is a lot ofthe psygoneic issues secondary?
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
Non-invasive options for Erectile Dysfunction treatment
- eliminate modifiable risk factors
- Counselling and/or psychotherapy
- medication
- vacuum constriction devices
Invasive therapy trreatments for ED
- Transurethtral drug application
- Intracavernous injection therapy
- Prosthesis implantation
- Venous/arterial surgery
Phosphodiestarase 5 inhibitors (PDE5) used are?
- Sildenafil: ‘viagra’
- Tadalafil: ‘Cialis’ longer duration of action, option of low dose (5mg) daily, (maintains oxygenation thus improving endothelial smooth muscle health)
- Vardenafil: ‘Levitra’, shorter duration of action
Other drug/physical approaches to ED treatment?
- Alprostadil injected into c.cavernosa
- ED shock wave theray
- Vacuum device
- Surgery
These can lead onto other issues!
What is rapid (premature) ejaculation?
When ejaculation occurs before the individual wants it to (subjective)
What are the traditional theories and responses to rapid/premature ejaculation
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
Neurobiological approach to erectile dysfuntion
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
Drug treatment for premature ejaculation
- Dapoxetine (priligyTM) 30mg or 60mg: main drug on the market, quickly metabolised!
- SSRI’s daily or clomipramine daily or 12 hours before sex
Delayed (retarded) ejaculation
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
Causes of Delayed Ejaculation
-
Hypofunction of 5-HT1A receptors
- and/or hyperfunction of 5-HT2c receptors
- Treament research into 5-HT1A receptor agonists -
Acquired DE
- Psychological
- Some disease states: neurological condition
- Meds: SSRIs, tricyclic ADs, antipsychotics
Criteria that mus be met for classification?
- Must be 75-100% of the time
- minimum duration of ~6months
- cause significant stress
Lifelong vs acquired
Severity scale
