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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
physiological causes of rapid ejaculation
``` genetic susceptibility e.g. neuroreceptor sensitivity penile hypersensitivity hyperthyroidism prostatitis erectile dysfunction sympathomimetic medication ```
26
psychological causes of rapid ejaculation
``` anxiety early learned states lack of (frequent) experience relationship issues partner issues e.g. pain ```
27
medical management of rapid ejaculation
physical examination including DRE prostate topical anaesthetic: stud 100 spray medication: dapoxetine
28
psychological management of rapid ejaculation
couple psychotherapy behavioural interventions: stop, start squeeze, sensate focus, kegel exercises, mindfulness
29
what is delayed ejaculation
marked delay, infrequency or absence of ejaculation on akmost or all ocassions either generalised or situational without the individual desiring delay
30
physiological causes of delayed ejaculation
``` 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) ```
31
psychological causes of delayed ejaculation
insufficient stimulation/ poor arousal masturbation technique relationship factors: problems with the couple script poor body image, history of abuse
32
investigations for delayed ejaculation
physical examination: testes, epididymis, vasa, prostate blood tests: FBC, glucose, testosterone, B12, folate, PSA urine sample: spermatozoa and fructose
33
treatment options for delayed ejaculation
``` personal sexual growth program individual therapy couples therapy kegel exercises use of vibration/superstimulation ```
34
what is vaginismus
spasm of the pelvic floor muscles that surround the vagina causing occlusion of the vaginal opening and making penile entry difficult or impossible
35
physiological causes of vaginismus
medical conditions where vulva is sore e.g. thrush FGM congenital abnormalities
36
psychological causes of vaginismus
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
37
psychological and behavioural treatment of vaginismus
individual psychotherapy, integrated CBT breathing control and relaxation, self exploration, vaginal trainers, personal sexual growth program, kegel exercises
38
Dyspareunia
pain during intercourse excluding other sexual dysfunction e.g. vaginismus or vaginal dryness
39
physiological causes of dyspareunia
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
psychological causes of dyspareunia
previous sexual abuse, poor sexual education, insufficient relaxation poor technique or speed of partner; fear of intimacy, anger or resentment towards partner
41
psychological management of dyspareunia
personal sexual growth program couple therapy sensate focus
42
what is personal sexual growth program
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
what is sensate focus
A staged programme of exercises to enable the couple to identify own and others sexual likes/dislikes and explore new techniques etc.
44
features of a relationship history
1. family background 2. social history (school, teachers, friends, work) 3. relationship history 4. relevant health history 5. current life situation
45
main relationship issues
``` communication timetabling conflict resolution difficulties with compromise power issues trust issues sexual problems ```
46
What are Petok's 4 principles
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
what things can influence a relationship in terms of diversity
chronic illness religion culture
48
how an chronic illness affect relationships
``` 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
what are the four main relationship therapy approaches
CBT Psychodynamic systemic integrative
50
what does CBT involve
Focuses on dysfunctional patterns of thoughts, beliefs and behaviour in the here-and-now
51
what does psychodynamic therapy involve
Focuses on the relationship between current problems and earlier patterns of response and behaviour from earlier life and takes into account unconscious processes
52
what is systemic relationship therapy
Focuses on process and context rather than and content to bring about change which is not necessarily based on understanding and intent
53
what is integrative relationship therapy
Uses understanding and interventions from more than one approach Can appear to offer the best of possible worlds but has risks and limitations
54
what is paraphilia
disorder of sexual preference causing distress or interpersonal difficulties
55
fetishism
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
Fetishistic transvestism
the wearing of clothes of the opposite sex to obtain sexual excitement
57
Fetishistic transvestism
the wearing of clothes of the opposite sex to obtain sexual excitement
58
exhibitionism
persistent tendency to expose genitalia to strangers in public spaces without their consent, in order for sexual arousal and gratification
59
voyeurism
persistent tendency to observe people in sexual or intimate acts, without their consent, in order for sexual arousal and gratification
60
paedophilia
sexual preference for children of prepubertal age
61
sadomasochism
preference for sexual activity which involves pain, humiliation or bondage sadist: enjoys providing masochist: enjoys receiving it
62
necrophilia
sexual arousal and gratification from contact with dead people
63
coprophilia
sexual arousal and gratification from contact with faeces
64
klismaphilia
sexual arousal and gratification from receiving enemas
65
urophilia
sexual arousal and gratification from contact with urine
66
zoophilia
sexual arousal and gratification from contact with animals
67
telephone scatalogia
sexual arousal and gratification through obscene sexual phone calls to a non consenting partner
68
frotteurism
sexual arousal and gratification from rubbing up against people in crowded places
69
what is sexual aversion disorder
repulsion or aversion to sex causing distress or problems in the relationship
70
anejaculation
pathological inability to ejaculate in males with/without orgasm
71
hypospadias
urethral opening not at top of penis
72
azoospermia
no sperm in ejaculate
73
Peyronie's disease
shaft of penis (tunica albicans) has plaques causing bend/twist in penis + dyspareunia treatment: watch/wait 12 months; surgery
74
vulvodynia
pain in the vulva without any identifiable cause
75
sex assigned at birth
male/female based on external genitalia
76
gender identity
intrinsic sense of being male, female or alternative
77
gender role/expression
personality appearance and behaviour
78
what are male primary sexual characteristics
penis and scrotum | maturation of testes
79
what are male secondary sexual characteristics
enlargement of genitalia lowering of voice pitch redistribution of muscle tissue and fat pubic facial body and armpit hair
80
what are female primary sexual characteristics
vagina and other internal genitalia vulva and other external genitalia ovaries
81
what are female secondary sexual characteristics
enlargement of genitalia development of breasts pubic and armpit hair
82
what is klinefelter's syndrome
boys/males born with an extra x chromosomes can cause infertility and low sex drive
83
what is congenital adrenal hyperplasia
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
what is transgender
diverse gender variance including transexual, gender queer and agender
85
gender dysphoria
distress due to incongruence between gender identity and sex assigned at birth for at least 6 months
86
transsexual
individuals who seek to change or have changed their primary and or secondary sex characteristics
87
sexual orientation
sex of person to whom sexual fantasies, arousal and activities are directed to
88
Transmale management
``` social transition, psychotherapy, occupational therapy fertility options androgens + GNrH analogue voice + communication hysterectomy bilateral oophorectomy phalloplasty ```
89
transfemale management
``` social transition, psychotherapy, occupational therapy fertility options oestrogens + antiandrogens voice + communication laser hair removal augmentation mammoplasty facial feminisation surgery Penectomy ```
90
hormone profile
``` TSH/T3/T4 Progesterone prolactin oestrogen FSH/LH insulin androgens/testosterone sex hormone binding globulin ```

Phase 3A (9 decks)

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