Psychosexual

Question 1

HIstory taking in psychosexual history key points to hit?

Answer 1

Confirm confidentiality, psychiatric history, background of patient, their family/siblings, relationships, schooling, work
Forensic history
Medication history - SE from drugs
Age at puberty
Age at first erection or period
How do they view their sexual orientation, identity
Any traumtic sexual experiences
Fantasies?
Age they first had sex? number of sexual partners? quality of relationships? reasons for ending?
Current relationship - Mismatch in libido? what do you do during sex? porn use?
STIs and contraception?
Obstetric history? social services involvement?

Question 2

Specific aspects of psychosexual history relating to the man?

Answer 2

Any sexual difficulties - erection, ejaculation? sex drive?
Early morning erections?
Have you ever had treatment before?

Question 3

Specific aspects of psychosexual history relating to the woman?

Answer 3

Periods?
Problems with arousal or orgasm?
Anatomical issues - Pain on intercourse? Penetration issues?

Question 4

What are some of the causes of sexual desire issues in men?

Answer 4

Androgen deficiency
Hyperprolactinaemia
Depression
Renal failure
Heart disease
Antidepressant medication
Relationship issues
Epilepsy
Anxiety 
Ageing
HIV
Alcohol

Question 5

Possible treatment options for male sexual desire disorders?

Answer 5

Correct underlying issue
Correct any low testosterone levels
Psychotherapy or sex therapy
Stop of change drugs that may be affecting

Question 6

Organic causes of erectile dysfunction in men?

Answer 6

Diabetes
Parkinson's disease
Temporal lobe epilepsy
Dementia
Thyroid dysfunction
Hypogonadism
Raised prolactin
CAD
Drug induced

Question 7

Psychogenic ED?

Answer 7

Related to partener, performance

Question 8

1st line treatment for ED including drug class and 2 examples of a short acting and 1 of a long acting?

Answer 8

Phosphodiesterase 5 inhibitors
Viagra - sildenafil (SA)
Cialis - tadalafil (SA)
Vardenafil (LA)

Question 9

What are the common side effects experienced with ED drugs?

Answer 9

Flush
Headache
Palpitations
Tachycardia
Vomiting 
Nausea

Question 10

2 second line treatments for erectile dysfunction?

Answer 10

Intracavernosal injections

Intraurethral therapy

Question 11

3rd line treatment option for erectile dysfunction?

Answer 11

Penile prosthesis

Question 12

2 drug treatment for premature ejaculation? psychological treatments?

Answer 12

SSRI
Clomipramine (TCA)
CBT, squeeze technique

Question 13

Causes of decreased sexual desire in women?

Answer 13

Female androgen insufficiency
Depression and mood disorders
Hyperprolactinaemia
Pregnancy or lactation
Age
Renal failure
CAD
Sexual abuse, stress, psychotic disorders

Question 14

What is the physiology behind vaginismus?

Answer 14

Spasming of the pelvic floor muscles causing occlusion of the vaginal opening

Question 15

Risk factors for vaginismus?

Answer 15

Education
Ethnicity 
OCP
Pregnancy
Time around ovulation
PID
Menopause
Sexual abuse or rape

Question 16

Endocrine issues which can lead to anorgasmia?

Answer 16

Diabetes
Hyperprolactinaemia
Androgen insufficiency - low testosterone or oestrogen

Question 17

Causes of anorgasmia in women?

Answer 17

Endocrine - diabetes, hyperprolactinaemia, androgen insufficiency
Trauma - spinal cord, MS
CV disease
Drug related

Question 18

Treatment of anorgasmia in women?

Answer 18

PDE 5 inhibitors

Review medications

Question 19

Examples of drugs that increase prolactin?

Answer 19

Methadone
Antipsychotics
Antiemetics - metoclopramide
H2 blockers - cimetidine
Antihypertensives - reserpine, clonidine, methyl dopa
Oestrogens

Question 20

Drugs that cause ED?

Answer 20

Antipsychotics
Antidepressants
H2 blockers - cimetidine
alpha blockers
beta blockers
antihypertensives - reserpine, clonidine, methyldopa
Thiazide diuretics
Cigarettes
Alcohol

Question 21

How do TCAs effect sexual function?

Answer 21

ED
Delayed orgasm
Reduced libido
Impaired ejaculation - clomipramine is worst

Question 22

How do SSRIs effect sexual performance?

Answer 22

ED
Delayed orgasm
Reduced libido (paroxetine)
Reduced lubrication (paroxetine worst)