Other:SexualMed Flashcards
What is hypoactive sexual desire disorder?
- lack or loss of sexual desire
- persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies + desire for sexual activity
Causes of male hypoactive sexual desire disorder?
Chronic medical conditions
- obesity
- CVD
- DM
- anaemia
Hormonal disorders
- androgen deficiency
- hypogonadism from various causes
- hyperprolactinaemia
Medication
- antidepressants
- finisteride
- post-orchidectomy
Physiological
- depression
- anxiety
- substance misuse
- psychological experiences (e.g. stress)
- body image disorder
- couples script problems
- erotic dissatisfaction
- couple relationship problems.
Causes of female hypoactive sexual desire disorder
Hormonal
- androgen deficiency
- post-pregnancy
- hypothyroidism
Medication
- oral contraceptive pill
- oral HRT
- tamoxifen
- antidepressants
- beta blockers
Psychosexual treatment options for hypoactive sexual desire disorder?
- Integrative (combination of psychosexual options + physical treatments)
e. g. CBT - Testosterone replacement
- Individual therapy (e.g. sex education + communication)
- Behavioural intervention (sexual growth programme)
What is erectile disorder?
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
- marked difficulty in obtaining erection during sexual activity
- marked difficulty in maintaining an erection until completion of sexual activity
- marked decrease in erectile rigidity
Causes of erectile disorder?
Physiological
- chronic medical conditions (e.g CVD, DM)
- hormonal disorders (androgen deficiency, hyperprolactinaemia)
- iatrogenic (post prostate surgery, anti depressants)
- age-related changes
Psychological
- mental health conditions (E.g. depression + anxiety)
- performance anxiety
- couples script problems
- relationship issues
- cultural + religious matters
What is medical treatment for erectile dysfunction?
Oral
- sildenafil (viagra)
- avanafil (spedra)
Injectable
- alprostadil (intracavernosal injection)
Intraurethral
- alporstadil pellet
- alprostadil cream
How should you educate the patient when using medication for erection problems?
- need sexual stimulation to work
- work best on empty stomach
- need to wait 45-60mins before sexual activity
- efficacy improves from 1st dose - 8th
non-medical treatment for erectile dysfunction?
Vacuum device
Penile/scrotal rings
New-stimulating routines (e.g. lubricants + vibration)
Kegel exercises
What is female sexual arousal disorder?
- failure of genital response
- lack of, or significantly reduced, sexual interest/arousal, as manifested by at least 3 of the followings:
1) absence/reduced interest in sexual activity
2) absence/reduced sexual/erotic thoughts or fantasies
3) reduced/no initiation of sexual activity and typically unreceptive to partner’s attempts to initiate
4) absence/reduced sexual excitement during activity
5) reduced interest in response to any external or internal cue
6) absence/reduced genital or non-genital sensations during sexual activity
physiological causes of female sexual arousal disorder?
Chronic medical conditions
- CVD
- DM
- Neuro disease
- Chronic fatigue syndrome
Hormonal disorders
- oestrogen deficiency (e.g. post-menopause)
Iatrogenic
e.g. antidepressants
Lactation
Local irritants + douching
psychological causes of female sexual arousal disorder?
MH conditions
- depression + anxiety
Previous abuse
Couples script problems
Decreased intimacy
Couple-relationship problems
Tx for female sexual arousal disorder?
Couples psychosexual therapy
- timetabling
- communication
- negotiation
- addressing intimacy
- being sexual
Behavioural interventions
- sensate focus
- new sexual routines
- eros therapy device
What is female orgasmic disorder?
Orgasm either does not occur or is markedly delayed.
- marked delayed in, marked infrequency of, or absence of orgasm.
- markedly reduced intensity of orgasmic sensations
Tx of female orgasmic disorder?
Bloods, exam, topical oestrogen
Individual psychotherapy with sex therapy focus
Behavioural interventions (e.g. education, guided masturbation, lubricant + vibration)
How can menopause effect sexual function?
- physical discomfort (e.g. sleeplessness, night sweats)
- vaginal or pelvic pain
- vaginal atrophy
- dryness
- changes in self-image, mood, memory, cognition
- changes in desire
- relationship factors
What is rapid ejaculation?
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction (<1min.)
Causes of rapid ejaculation?
Physiological
- genetic susceptibility (neuroreceptor sensitivity)
- penile hypersensitivity
- hyperthyroidism
- prostatitis
- co-morbid sexual problems (e.g. ED)
- sympathomimetic medication
Psychological
- anxiety state
- early learned experiences
- lack of experience/infrequent sex
- environmental factors
- relationship issues
- partner issues (e.g. pain)
Tx of rapid ejaculation
- physical exam inc DRE
- topical local anaesthetic
- medication (e.g. dapoxetine - SSRI)
- couple psychosexual therapy
- behavioural interventions (e.g. stop, start/squeeze)
What is delayed ejaculation?
Marked delay in ejaculation
Marked infrequency or absence of ejaculation
Causes of delayed ejaculation?
Physiological - congenital disorders - trauma or surgery - depression - age - infectious diseases - diabetes mellitus - SSRIs - decreased testosterone EXCLUDE RETROGRADE EJACULATION
Psychological
- insufficient stimulation
- masturbation technique
- individual vulnerability factors (e.g. poor body image)
- outgrowth of psychic conflict (e.g. fear)
- relationship factors
- partner issues
- secondary to other sexual problems
How do you exclude retrograde ejaculation in delayed ejaculation?
Ask them to pass urine and see if it is cloudy after ejaculation.
Tx for delayed ejaculation
PSGP Individual therapy Couples therapy Kegel exercises Use of stimulation
What is vaginismus?
Spasm of pelvic floor muscles that surround vagina causing occlusion of vaginal opening. Penile entry is either impossible or painful.
Causes of vaginismus?
Physiological
- medical conditions (e.g. thrush)
- other pain conditions
- FGM
- congenital abnormality
Psychological - misinformation + mistaken belief >vagina too small >no opening >first intercourse painful
- religious or cultural issues
- fear of pregnancy
- previous sexual abuse
- fear or dislike of partner
- situational
Tx for vaginismus
Individual psychosexual therapy
Integrated CBT
Behavioural interventions (e.g. breathing control + relaxation, self-exploration)
What is dyspareunia?
Pain during intercourse
Occurs in men + women and can be attributed to local pathology
Criteria for dyspareunia?
persistent or recurrent difficulties with 1 or more of:
- vaginal penetration during intercourse
- marked vulvovaginal or pelvic pain during intercourse
- fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
- marked tensing/tightening of pelvic floor muscles during attempted penetration
causes of dyspareunia?
Physiological
- Manipulation: infection, injury, irritation, lesions, hypersensitivity
- Introitus (pain on entry): episiotomy, recurrent infection, allergies, urethritis, menopause, insufficient arousal, herpes
- Mid/deep vaginal pain: endometriosis, short vagina, uterine retroversion, pelvic tumour, IBS
Psychological
- previous experience of pain
- previous sexual abuse
- poor sexual education
- poor understanding of anatomy + physiology
- insufficient relaxation
- unpleasant gynae exam
Relationship
- poor technique of partner
- speed/timing of partner
- fear of intimacy
- anger towards partner
Tx of dyspareunia?
Steroid cream
Couple therapy
Personal sexual growth programme
Sensate focus
What are the main relationship issues?
- communication issues
- timetabling
- conflict resolution
- compromise difficulties
- power issues
- trust issues
- sexual issues
What are petoks 4 principles?
1) ask about religious beliefs during initial visit
2) ask about religious teachings regarding sexual behaviour
3) when in doubt, consult with a religious expert
4) help couples set reasonable expectations consistent with their beliefs
What are the main factors in the impact of chronic illness in relationships?
- life threatening illness can lead to withdrawal
- tiredness, low mood, anxiety
- disturbance of body image
- disturbance of roles + life normatives
- limitations on mobility
- disturbance of mental functioning
- postponement of breakdown
What is sexual aversion disorder?
Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner.
Marked distress or interpersonal difficulty.
What is male hypoactive sexual desire disorder?
Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity.
(Take into context the age, sexual functioning and context of the persons life)
Marked distress or interpersonal difficulty (ICD)
Loss of or lack of sexual desire as the principal problem and not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not preclude sexual enjoyment or arousal but makes initiation of sexual activity less likely (DSM-5)
what is female sexual interest/arousal disorder?
Failure of genital response
• principle problem is vaginal dryness/lack of lubrication (ICD)
Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
• absent/reduced interest in sexual activity
• absent/reduced sexual/erotic thoughts or fantasies
• no/reduced initiation of sexual activity, and typically unresponsive to partners attempts to initiate
• absent/reduced sexual excitement phase/pleasure during sexual activity
• absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
• absent/reduced genital or non-genital sensations during sexual activity (DSM-5)
what is erectile disorder?
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse (ICD)
- Marked difficulty in obtaining an erection during sexual activity
- Marked difficulty in maintaining an erection until the completion of sexual activity
- Marked decrease in erectile rigidity (DSM-5)
What is orgasmic disorder?
Orgasm either does not occur or is markedly delayed (ICD)
- Marked delay in, marked infrequency of, or absence of orgasm
- Marked reduced intensity of orgasmic sensations (DSM-5)
What is inhibited/delayed ejaculation?
Occurs almost or all occasions (75-100%) either generalised or situational, without the individual desiring the delay.
- marked delay in ejaculation
- marked frequency or absence of ejaculation.
May be lifelong or acquired, mild, moderate or severe (DSM-5)
Important to distinguish between ejaculation and orgasm in men
What is rapid ejaculation?
The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction (ICD)
- persistent or recurrent pattern of ejaculating occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it
- Note: Although the diagnosis of rapid ejaculation may be applied to individuals engaged in non-vaginal sexual activities, specific duration criteria have not been established for these activities (DSM-5)
What is retrograde ejaculation?
Occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Sometimes called ‘dry orgasm’.
What is dyspareunia?
Pain during intercourse in either women or men. Often attributed to local pathology and should then be properly categorised under the pathological condition. This category is to be used only if there is no primary nonorganic sexual dysfunction and NOT CAUSED BY VAGINISMUS OR LACK OF LUBIRCATION (ICD)
Genito-Pelvic Pain/Penetration Disorder, persistent or recurrent difficulties with one of the following:
• vaginal penetration during intercourse
• marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
• marked fear of anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
• marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. (DSM-5)
What is vaginismus?
Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful (ICD)
Genito pelvic pain/penetration disorder, persistent or recurrent difficulties with one or more of the following:
• vaginal penetration during intercourse
• marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
• marked fear of anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
• marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. (DSM-5)
What is vulvodynia?
Vulvodynia is persistent, unexplained pain in the vulva (the skin surrounding the entrance to the vagina).
It can affect women of all ages, and often occurs in women who are otherwise healthy.
Vulvodynia can be a long-term (chronic) problem that’s very distressing to live with, but much can be done to help relieve the pain.
Unfortunately, many doctors are unaware that these conditions even exist, and may mistakenly suggest to patients that this is a psychological condition. It is common for women with vulvodynia to suffer for many years and see many doctors before being correctly diagnosed.
What is Peyronie’s disease?
Peyronie’s disease (PD), which is characterised by fibrous plaque formation in the tunica albuginea of the penis, is associated with pain, erectile dysfunction, and anatomical malformations that negatively affect the quality of life of affected men. Can cause penile deformity in terms of bending, twisting or banding or penis.
What is azoospermia?
Absence of sperm in the ejaculate.
What is hypospadias?
Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (opening). Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum. A distal hypospadias may be suspected even in an uncircumcised boy from an abnormally formed foreskin and downward tilt of the glans.
what is anejaculation?
Pathological inability to ejaculate in males, with (orgasmic) or without (anorgasmic) orgasm.
What is paraphilia?
Abnormal sexual desires
Define fetishism?
Sexual arousal from non-sexual body parts/things
Define transvestic fetishism?
Sexual arousal from cross-dressing
Define necrophilia?
Sexual arousal from dead bodies
Define klismaphilia
sexual arousal from receiving an enema
Define coprophilia
sexual arousal from contact with faeces
Define zoophilia
sexual arousal from genital contact with animals
Define urophilia
sexual arousal from contact with urine or watching others wee
Define masochism
sexual arousal from humiliation/suffering on one self, repeatedly and intentionally
Define sadism
sexual arousal from humiliating/causing suffering to someone else, repeatedly and intentionally
Define sadomasochism?
sexual arousal from being humiliated AND humiliating others
Define exhibitionism?
sexual arousal from exposing genitals/masturbating in public. Public displays without consent.
Define telephone scatologia?
sexual arousal from repetitive telephone calls with sexual content to a non-consented individual
Define frotterurism
sexual arousal from rubbing genital against another person, usually in crowd
Define paedophilia
sexual arousal from children
Define sex addiction
uncontrollable/excessive sexual desire with a compulsive element.
what is gender dysphoria?
a marked incongruence between one’s experienced/expressed gender and assigned gender of at least 6 months duration, as manifested by at least 2 of the following:
1) marked incongruence between one’s gender and primary or secondary sex characteristics
2) strong desire to be rid of one’s primary or secondary sex characteristics
3) strong desire for primary or secondary characteristics of other gender
4) strong desire to be other gender
5) strong desire to be treated as other gender
6) strong conviction that one has typical feelings of other gender
management of a transmale?
- assessment + diagnosis
- social transition +/- psychotherapy
- fertility options
- androgens +/- GnRH analogue
- voice + communication
- male chest reconstruction
- hysterectomy + bilateral oopherecotmy
- phalloplasty/metoidoplasty
management of a transfemale?
- assessment + diagnosis
- social transition +/- psychotherapy
- fertility options
- oestrogen +/- anti-androgens
- voice + communication
- facial hair removal
- vaginaplasty
- augmentation mammoplasty
- facial feminisation surgery
What is gender identity?
intrinsic sense of being male/female/alternative
what is gender role/expression?
personality, appearance and behaviour
what is transgender?
diverse gender variants including transexual, gender queer and agender
what is gender dysphoria?
distress due to incongruence between gender identity and sex assigned at birth
what is transexual?
individuals who seek to change or have changed their primary or secondary sex characterisitcs
What is transmale? (FtM)
female at birth, changing to male body
what is transfemale (MtF)
male at birth, changing to female body
what is sexual orientation?
sex of persons’ to whom sexual arousal, fantasies or activities directed.
