Psychosexual Flashcards
HIstory taking in psychosexual history key points to hit?
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?
Specific aspects of psychosexual history relating to the man?
Any sexual difficulties - erection, ejaculation? sex drive?
Early morning erections?
Have you ever had treatment before?
Specific aspects of psychosexual history relating to the woman?
Periods?
Problems with arousal or orgasm?
Anatomical issues - Pain on intercourse? Penetration issues?
What are some of the causes of sexual desire issues in men?
Androgen deficiency Hyperprolactinaemia Depression Renal failure Heart disease Antidepressant medication Relationship issues Epilepsy Anxiety Ageing HIV Alcohol
Possible treatment options for male sexual desire disorders?
Correct underlying issue
Correct any low testosterone levels
Psychotherapy or sex therapy
Stop of change drugs that may be affecting
Organic causes of erectile dysfunction in men?
Diabetes Parkinson's disease Temporal lobe epilepsy Dementia Thyroid dysfunction Hypogonadism Raised prolactin CAD Drug induced
Psychogenic ED?
Related to partener, performance
1st line treatment for ED including drug class and 2 examples of a short acting and 1 of a long acting?
Phosphodiesterase 5 inhibitors
Viagra - sildenafil (SA)
Cialis - tadalafil (SA)
Vardenafil (LA)
What are the common side effects experienced with ED drugs?
Flush Headache Palpitations Tachycardia Vomiting Nausea
2 second line treatments for erectile dysfunction?
Intracavernosal injections
Intraurethral therapy
3rd line treatment option for erectile dysfunction?
Penile prosthesis
2 drug treatment for premature ejaculation? psychological treatments?
SSRI
Clomipramine (TCA)
CBT, squeeze technique
Causes of decreased sexual desire in women?
Female androgen insufficiency Depression and mood disorders Hyperprolactinaemia Pregnancy or lactation Age Renal failure CAD Sexual abuse, stress, psychotic disorders
What is the physiology behind vaginismus?
Spasming of the pelvic floor muscles causing occlusion of the vaginal opening
Risk factors for vaginismus?
Education Ethnicity OCP Pregnancy Time around ovulation PID Menopause Sexual abuse or rape
Endocrine issues which can lead to anorgasmia?
Diabetes
Hyperprolactinaemia
Androgen insufficiency - low testosterone or oestrogen
Causes of anorgasmia in women?
Endocrine - diabetes, hyperprolactinaemia, androgen insufficiency
Trauma - spinal cord, MS
CV disease
Drug related
Treatment of anorgasmia in women?
PDE 5 inhibitors
Review medications
Examples of drugs that increase prolactin?
Methadone Antipsychotics Antiemetics - metoclopramide H2 blockers - cimetidine Antihypertensives - reserpine, clonidine, methyl dopa Oestrogens
Drugs that cause ED?
Antipsychotics Antidepressants H2 blockers - cimetidine alpha blockers beta blockers antihypertensives - reserpine, clonidine, methyldopa Thiazide diuretics Cigarettes Alcohol
How do TCAs effect sexual function?
ED
Delayed orgasm
Reduced libido
Impaired ejaculation - clomipramine is worst
How do SSRIs effect sexual performance?
ED
Delayed orgasm
Reduced libido (paroxetine)
Reduced lubrication (paroxetine worst)
