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Phase 3A > Psychosexual Medicine > Flashcards

Psychosexual Medicine Flashcards

1
Q

what investigations might be useful in the assessment of sexual problems

A
  • fasting glucose/lipid ratio
  • testosterone, sex hormone-binding globulin, albumin
  • prolactin
  • TSH
  • oestrogen
  • FBC
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2
Q

what is hypoactive sexual disorder

A

lack or loss of sexual desire not secondary to other sexual difficulties

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3
Q

what chronic medical conditions can cause HSDD

A

obesity
CVD
DM
anaemia

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4
Q

what hormonal problems can cause HSDD

A

M: androgen deficiency, hypogonadism, hyperprolactinaemia

F: androgen deficiency, hypothyroidism, hyperprolactinaemia, post pregnancy, addison’s disease

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5
Q

what are iatrogenic causes of HSDD

A

antidepressants, oral contraceptive/HRT, anti-psychotics, surgery (orchidectomy, bilateral oophorectomy)

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6
Q

what are psychological causes of HSDD

A

mental health conditions e.g. depression, anxiety, substance misuse
body image disorders
stress, life events, previous trauma or abuse
couple script problems or couple relationship problems
erotic dissatisfaction

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7
Q

HSD Treatment options

A

testosterone replacement (injections, transdermal patches, gels, buccal)
individual psychotherapy
sexual growth programme

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8
Q

what is erectile disorder

A

difficulty developing or maintaining an erection suitable for sexual satisfaction

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9
Q

what are physiological causes of ED

A

chronic medical conditions: CVD, DM, neurological disease

hormonal disorder: androgen deficiency, high prolactin

iatrogenic: post prostate surgery, antidepressants, anti hypertensives, beta-blockers

age related changes

ineffective sexual stimuli

pain

veno-occlusive disorder

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10
Q

psychological causes of ED

A

mental health conditions including substance misuse

performance anxiety, (prior) relationship issues

PTSD

cultural or religious matters

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11
Q

medical treatment for ED

A

oral (sildenafil, avanafil)

injectable: alprostadil (intracavernosal)
intraurethral: alprostadil

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12
Q

non medical treatment for ED

A

vacuum device
penile/scrotal rings
kegel exercises
enhancing lubricators

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13
Q

psychological treatment for ED

A

individual sexual and or couple therapy

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14
Q

what is female sexual interest/ arousal disorder

A

failure of genital response, the principle problem being vaginal dryness or failure of lubrication

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15
Q

what are physiological causes of FSI/AD

A

chronic medical conditions: CVD, DM, neurological disease, connective tissue disease, CFS

Hormonal disorders: oestrogen deficiency, thyroid disorders

iatrogenic: e.g. antidepressants

lactation

(vaginal dryness caused by local irritants and douching)

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16
Q

psychological causes of FSI/AD

A

mental conditions: depression, anxiety, binge eating disorders, excessive dieting

previous abuse

couple script/relationship problems

decreased intimacy

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17
Q

psychological management of FSI/AD

A

couples psychosexual therapy

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18
Q

non-medical/behavioural interventions for FSI/AD

A

sensate focus

eros therapy device, lubricants vibrators

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19
Q

what is female orgasmic disorder

A

orgasm does not occur or is markedly delayed

marked delay, infrequency absence or reduced intensity of orgasm

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20
Q

physiological causes of female orgasmic disorder

A

chronic medical conditions: CVD, DM, neuroligical conditions, renal/liver problems

hormonal disorders: oestrogen/androgen insufficiency; hypothyroidism

pelvic floor weakness, ageing

SSRIs

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21
Q

Psychological causes of female orgasmic disorder

A 
mental health conditions: depression, anxiety, substance misuse 
previous abuse 
couple script/relationship problems 
lack of understanding
environmental factors, stress
cultural and religious issues
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22
Q

female orgasmic disorder medical, psychological and behavioural management

A

topical oestrogen

individual psychotherapy with sex therapy focus

behavioural: education, personal sex growth program, guided masturbation, lubricant and vibrators, kegel exercises, relaxation, mindfulness

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23
Q

how can the menopause affect sexual function

A

vaginal or pelvic pain
vaginal atrophy
dryness
change in self image, mood, memory, cognition
changes in desire
physical discomfort: sleeplessness, night sweats

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24
Q

what is rapid ejaculation

A

the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction

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25
Q

physiological causes of rapid ejaculation

A 
genetic susceptibility e.g. neuroreceptor sensitivity 
penile hypersensitivity 
hyperthyroidism 
prostatitis 
erectile dysfunction 
sympathomimetic medication
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26
Q

psychological causes of rapid ejaculation

A 
anxiety 
early learned states 
lack of (frequent) experience 
relationship issues
partner issues e.g. pain
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27
Q

medical management of rapid ejaculation

A

physical examination including DRE prostate

topical anaesthetic: stud 100 spray

medication: dapoxetine

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28
Q

psychological management of rapid ejaculation

A

couple psychotherapy

behavioural interventions: stop, start squeeze, sensate focus, kegel exercises, mindfulness

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29
Q

what is delayed ejaculation

A

marked delay, infrequency or absence of ejaculation on akmost or all ocassions either generalised or situational without the individual desiring delay

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30
Q

physiological causes of delayed ejaculation

A 
congenital disorders 
neurological disorders e.g. spinal cord injury, alcohol neuropathy 
trauma or surgery 
age 
infection diseases
depression
medication: SSRI, thiazide, alpha blockers
low testosterone 
(exclude retrograde ejaculation)
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31
Q

psychological causes of delayed ejaculation

A

insufficient stimulation/ poor arousal
masturbation technique
relationship factors: problems with the couple script
poor body image, history of abuse

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32
Q

investigations for delayed ejaculation

A

physical examination: testes, epididymis, vasa, prostate
blood tests: FBC, glucose, testosterone, B12, folate, PSA
urine sample: spermatozoa and fructose

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33
Q

treatment options for delayed ejaculation

A 
personal sexual growth program 
individual therapy 
couples therapy 
kegel exercises 
use of vibration/superstimulation
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34
Q

what is vaginismus

A

spasm of the pelvic floor muscles that surround the vagina causing occlusion of the vaginal opening and making penile entry difficult or impossible

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35
Q

physiological causes of vaginismus

A

medical conditions where vulva is sore e.g. thrush
FGM
congenital abnormalities

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36
Q

psychological causes of vaginismus

A

misinformation (e.g. vagina is too small, 1st intercourse will be painful)
religious/cultural issues
previous abuse/trauma
unpleasant 1st sexual experience or gynaecological exam
fear/dislike of partner

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37
Q

psychological and behavioural treatment of vaginismus

A

individual psychotherapy, integrated CBT

breathing control and relaxation, self exploration, vaginal trainers, personal sexual growth program, kegel exercises

38
Q

Dyspareunia

A

pain during intercourse excluding other sexual dysfunction e.g. vaginismus or vaginal dryness

39
Q

physiological causes of dyspareunia

A

manipulation: infection, injury, irritation, lesion, hypersensitivity
introitus: episiotomy, circumcision, recurrent infections, poor lubrication, bartholin’s cyst, urethritis, lichen sclerosis, penis size

mid-deep vaginal pain: endometriosis, congenital shortened vagina, pelvic tumours, irritable bowel, constpation, surgical adhesions

40
Q

psychological causes of dyspareunia

A

previous sexual abuse, poor sexual education, insufficient relaxation

poor technique or speed of partner; fear of intimacy, anger or resentment towards partner

41
Q

psychological management of dyspareunia

A

personal sexual growth program
couple therapy
sensate focus

42
Q

what is personal sexual growth program

A

Enables patient to become aware of their own sexual needs through mindful self exploration of their physiological responses

Work with the therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour

43
Q

what is sensate focus

A

A staged programme of exercises to enable the couple to identify own and others sexual likes/dislikes and explore new techniques etc.

44
Q

features of a relationship history

A
  1. family background
  2. social history (school, teachers, friends, work)
  3. relationship history
  4. relevant health history
  5. current life situation
45
Q

main relationship issues

A 
communication
timetabling 
conflict resolution
difficulties with compromise 
power issues 
trust issues
sexual problems
46
Q

What are Petok’s 4 principles

A

ask about religious beliefs during initial visit
ask about religious teachings regarding sexual behaviour
when in doubt, consult with a religious expert
help couples set reasonable expectations consistent with their beliefs

47
Q

what things can influence a relationship in terms of diversity

A

chronic illness
religion
culture

48
Q

how an chronic illness affect relationships

A 
withdrawal (life-threatening)
tiredness, low mood, anxiety 
disturbance of body image
disturbance of roles and life narratives
limitations on mobility and social contact 
disturbance of mental functioning
49
Q

what are the four main relationship therapy approaches

A

CBT
Psychodynamic
systemic
integrative

50
Q

what does CBT involve

A

Focuses on dysfunctional patterns of thoughts, beliefs and behaviour in the here-and-now

51
Q

what does psychodynamic therapy involve

A

Focuses on the relationship between current problems and earlier patterns of response and behaviour from earlier life and takes into account unconscious processes

52
Q

what is systemic relationship therapy

A

Focuses on process and context rather than and content to bring about change which is not necessarily based on understanding and intent

53
Q

what is integrative relationship therapy

A

Uses understanding and interventions from more than one approach
Can appear to offer the best of possible worlds but has risks and limitations

54
Q

what is paraphilia

A

disorder of sexual preference causing distress or interpersonal difficulties

55
Q

fetishism

A

reliance on a non-living object as a stimulus for sexual arousal and gratification. Usually an extension of the human body e.g. shoes

56
Q

Fetishistic transvestism

A

the wearing of clothes of the opposite sex to obtain sexual excitement

57
Q

Fetishistic transvestism

A

the wearing of clothes of the opposite sex to obtain sexual excitement

58
Q

exhibitionism

A

persistent tendency to expose genitalia to strangers in public spaces without their consent, in order for sexual arousal and gratification

59
Q

voyeurism

A

persistent tendency to observe people in sexual or intimate acts, without their consent, in order for sexual arousal and gratification

60
Q

paedophilia

A

sexual preference for children of prepubertal age

61
Q

sadomasochism

A

preference for sexual activity which involves pain, humiliation or bondage

sadist: enjoys providing
masochist: enjoys receiving it

62
Q

necrophilia

A

sexual arousal and gratification from contact with dead people

63
Q

coprophilia

A

sexual arousal and gratification from contact with faeces

64
Q

klismaphilia

A

sexual arousal and gratification from receiving enemas

65
Q

urophilia

A

sexual arousal and gratification from contact with urine

66
Q

zoophilia

A

sexual arousal and gratification from contact with animals

67
Q

telephone scatalogia

A

sexual arousal and gratification through obscene sexual phone calls to a non consenting partner

68
Q

frotteurism

A

sexual arousal and gratification from rubbing up against people in crowded places

69
Q

what is sexual aversion disorder

A

repulsion or aversion to sex causing distress or problems in the relationship

70
Q

anejaculation

A

pathological inability to ejaculate in males with/without orgasm

71
Q

hypospadias

A

urethral opening not at top of penis

72
Q

azoospermia

A

no sperm in ejaculate

73
Q

Peyronie’s disease

A

shaft of penis (tunica albicans) has plaques causing bend/twist in penis + dyspareunia

treatment: watch/wait 12 months; surgery

74
Q

vulvodynia

A

pain in the vulva without any identifiable cause

75
Q

sex assigned at birth

A

male/female based on external genitalia

76
Q

gender identity

A

intrinsic sense of being male, female or alternative

77
Q

gender role/expression

A

personality appearance and behaviour

78
Q

what are male primary sexual characteristics

A

penis and scrotum

maturation of testes

79
Q

what are male secondary sexual characteristics

A

enlargement of genitalia
lowering of voice pitch
redistribution of muscle tissue and fat
pubic facial body and armpit hair

80
Q

what are female primary sexual characteristics

A

vagina and other internal genitalia
vulva and other external genitalia
ovaries

81
Q

what are female secondary sexual characteristics

A

enlargement of genitalia
development of breasts
pubic and armpit hair

82
Q

what is klinefelter’s syndrome

A

boys/males born with an extra x chromosomes can cause infertility and low sex drive

83
Q

what is congenital adrenal hyperplasia

A

an inherited disorder that results in low levels of cortisol and high levels of male hormones, causing development of male characteristics in females, and early puberty in both boys and girls.

84
Q

what is transgender

A

diverse gender variance including transexual, gender queer and agender

85
Q

gender dysphoria

A

distress due to incongruence between gender identity and sex assigned at birth for at least 6 months

86
Q

transsexual

A

individuals who seek to change or have changed their primary and or secondary sex characteristics

87
Q

sexual orientation

A

sex of person to whom sexual fantasies, arousal and activities are directed to

88
Q

Transmale management

A 
social transition, psychotherapy, occupational therapy 
fertility options
androgens + GNrH analogue 
voice + communication
hysterectomy 
bilateral oophorectomy 
phalloplasty
89
Q

transfemale management

A 
social transition, psychotherapy, occupational therapy 
fertility options
oestrogens + antiandrogens 
voice + communication
laser hair removal
augmentation mammoplasty
facial feminisation surgery
Penectomy
90
Q

hormone profile

A 
TSH/T3/T4
Progesterone
prolactin
oestrogen
FSH/LH
insulin
androgens/testosterone 
sex hormone binding globulin

Phase 3A (9 decks)

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