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