Loss of Libido and sexual dysfunction Flashcards
What are the causes of loss of libido
Hypoactive sexual desire dysfunction (HSDD)
Depression, Anxiety
Hypothyroidism, hyperprolactinaemia
Neglect, abuse (verbal/emotional/sexual), trauma
Poor quality of the current interpersonal relationship, lack of sexual environment and sexual stimuli
Iatrogenic: antidepressants, oophorectomy, substance use
What is Hypoactive sexual desire dysfunction (HSDD)
Absence or significant reduction of sexual desire:
Lack of spontaneous sexual thoughts and fantasies
Lack of desire in response to erotic cues and stimulation
Inability to sustain interest in sexual activity after starting
What is the management for Hypoactive sexual desire dysfunction (HSDD)
Address and physical causes
Psychological
- Tailored sexual education
- Sensate focus therapy
Social
- Encourage open communication between partners
- Sex timetabling to help find compromise
Describe sensate focus therapy
Intercourse is initially banned
Non-genital caressing that focuses on pleasure and relaxation
Genital touching focusing on arousal, and subsequently orgasm
Intercourse often occurs naturally, with time
What is Compulsive sexual behaviour disorder (CSBD)
Persistent pattern of uncontrolled, intense, repetitive sexual urges resulting in repetitive sexual behaviour for at least 6 months, causing pronounced distress or functional impairment
What are the causes of increased libido
Compulsive sexual behaviour disorder (CSBD)
Mania
Substance use
Frontal lobe syndrome
Testosterone, oestrogen use
Antiparkinsonism medication
What is Female sexual arousal dysfunction
Absence or marked reduction of a woman’s response to sexual stimulation, evidenced by absent/markedly reduced genital response e.g. vulvovaginal lubrication, non-genital response e.g. increase HR, feelings (excitement and pleasure)
What are the causes of Female sexual arousal dysfunction
Organic: vaginal atrophy, infection
Psychological: anxiety
What is the management for Female sexual arousal dysfunction
Lubricating gels
Hormone replacement therapy
Psychological therapy
What are the causes of erectile dysfunction
Organic:
Vascular e.g. diabetes, arteriosclerosis
Neurological e.g. MS< autonomic neuropathy, surgical or trauma nerve injury
Iatrogenic e.g. antidepressants, antipsychotics, anti-hypertensives, beta-blockers, diuretics
Substance use, especially alcohol (“brewer’s droop”)
Pituitary failure e.g. Klinefelter syndrome, mumps
Peyronie disease
Priapism (prolonged erection → scarring)
Psychosocial
Performance anxiety
Depression
Relationship problems
Cultural factors
Lack of knowledge/experience
What investigations should be done for erectile dysfunction
Bedside: CBG
Bloods: testosterone, prolactin, HbA1c, LFTs
What is the management for erectile dysfunction
Address modifiable risk factors e.g. smoking, weight, alcohol use, diabetes, HTN
Consider switching causative medications
Psychological treatment: sensate focus therapy or CBT
Pharmacological:
- Phosphodiesterase-5 inhibitors e.g. sildenafil (viagra)
- Self-administered intracavernosal prostaglandin injections before intercourse
- Vacuum pumps: plastic dome and pump placed over the penis to create a vacuum, producing an erection that is maintained by a tight ring placed around the base of the penis
What are the causes of anorgasmia
Neurodegenerative conditions
Medications e.g. antidepressants
Alcohol use
Depression
Relationship factors
Cultural factors
Lack of knowledge/experience
Previous abuse
Lack of connection with partner
What is the management for early ejaculation
Improves with experience
Stop-start technique (squeeze the glans penis) SSRIs
Review medication e.g. antiparkinsonian medication
What is the management for delayed ejaculation
psychological therapy
advice sexual techniques
medication review e.g. antidepressants
What are the features of Sexual pain penetration disorder (SPPD) / vaginismus
Significant difficulty attaining penetration due to involuntary tightening of the pelvic floor muscles
Marked pelvic pain during penetration
Fear of vulvovaginal or pelvic pain before, during, or after intercourse
Cannot be explained by organic condition, mental health disorder, inadequate lubrication, or age-related changes
What are the risk factors for Sexual pain penetration disorder (SPPD) / vaginismus
Sexual anxiety
Previous sexual assault or abuse
What is the management for Sexual pain penetration disorder (SPPD) / vaginismus
Education
Relaxation
Self-exploration
Pelvic floor exercises
Vaginal ‘trainers’ (plastic, tampon-like objects) of increasing sizes
What are the causes of dyspareunia in women
Infection
Episiotomy
Endometriosis
Tumour
Vaginal dryness
What are the causes of dyspareunia in men
Urethritis
Prostatitis
