sex function and dysfunction

Question 1

sexual response cycle

Answer 1

desire > excitement > plateau > orgasm > resolution

Question 2

desire phase

Answer 2

innate- similar to appetite. Can be augmented or inhibted by learned responses and experiences. Different than attraction. Partially under influence of estrogen and testosterone

Question 3

describe elements of attraction

Answer 3

Modifiable elements – age, body habitus, personality/maturity. Constant elements – gender, “type”

Question 4

causes of desire disorders

Answer 4

performance anxiety or aversion

Question 5

Arousa/ excitement phase

Answer 5

Increased pulse/ respiration. Shifts in blood flow to pelvis and genitalia- Erection on men, Clitoral engorgement, vaginal expansion and lubrication, uterine elevation in women. Shift in blood flow to skin- “Flush”, feeling of warmth, sweating. Nipple erection

Question 6

What causes an erection

Answer 6

increased penile blood flow resulting from the relaxation of penile arteries and corpus cavernosal smooth muscle. mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cyclic GMP in smooth muscle cells. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum

Question 7

orgasm phase

Answer 7

series of rhythmic contractions of the perineal muscles occurring every 0.8 seconds. In the male it is accompanied by 3 to 7 ejaculatory spurts of seminal fluid. In the female it is accompanied by elevation of the “orgasmic platform” - posterior vaginal wall. In both sexes there are involuntary contractions of skeletal muscles and EEG changes.

Question 8

resolution phase- males

Answer 8

In males, orgasm is followed by an obligatory resolution phase in which physiologic changes return to baseline and further stimulation cannot produce excitement. The length of the resolution phase varies with age, ranging from less than 5 minutes in adolescents to 24 hours or longer in elderly men

Question 9

resolution phase- females

Answer 9

In females resolution is not always obligatory—women may return to plateau and have repeated orgasm without resolution to a basal state. Some women do have an obligatory resolution phase

Question 10

3 questions to ask in ROS for sexual history

Answer 10

Are you in a sexual relationship? How often do you have intercourse? Women -Do you have pain with intercourse?How often do you have orgasm with intercourse? Men – Do you have problems getting or keeping an erection? Do you ejaculate before you want?

Question 11

Desire phase disorders

Answer 11

Low libido - Hypoactive Sexual Desire Disorder: Usually associated with chronic disease, depression, hypoestrogenic states. Inhibited sexual desire - Sexual Aversion Disorder : Result of pain or other dysfunction. Sexual aversion and HSDD are a continuum

Question 12

arousal/ excitement phase disorders

Answer 12

Male erectile disorder, Female sexual arousal disorder, Premature ejaculation, Dyspareunia, Vaginismus

Question 13

criteria for Female Sexual Arousal Disorder

Answer 13

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement. Causes distress or interpersonal difficulty

Question 14

components of female aroused state

Answer 14

Labia minora: increased blood flow, engorgement. Clitoris: increased blood flow, engorgement. Vagina: increased length and width, increased blood flow, increased lubrication

Question 15

Why isnt there a “viagra” for female sex arousal disorder

Answer 15

Disconnect between objective measures of vasocongestion and subjective arousal. Conditioned negative response to arousal. Drug therapy without education/psychotherapy is less likely to be successful

Question 16

describe dyspareunia

Answer 16

Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female causing distress. May be introital, vaginal or deep and may be reproduced on exam

Question 17

cycle of dyspareunia

Answer 17

pain with intercourse > inhibited desire/ sexual aversion > failure of excitement > lack of lubrication and expansion

Question 18

describe vaginismus

Answer 18

Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. May make penetration impossible. Causes: pain, religious orthodoxy, severe negative parental attitudes

Question 19

Plateau phase disorders

Answer 19

female orgasmic disorder, delayed ejaculation/ male orgasmic disorder

Question 20

Define female/male orgasmic disorder

Answer 20

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm.

Question 21

sensate focus therapy

Answer 21

12-16 vsits involving behavioral modification, marital therapy. Focus on sensations and emotions and recognize that same stimulus does not give same response

Question 22

bibliotherapy

Answer 22

Assign readings to patients. Most successful in orgasmic dysfunction

Question 23

Which drugs can have sex side effects

Answer 23

contraceptives, anti-hypertensives, Anti-epileptics, Psycho-active drugs, Illicit/recreational drugs

Question 24

contraceptives side effects

Answer 24

OCPs- little evidence. Depo provera- hypoestrogenic state and atrophic vaginitis. Decreased libido in 1.6-15%

Question 25

Antihypertensives sex side effects

Answer 25

can affect sexual function by acting on the central or peripheral nervous system, the vascular system, or by having hormonal effects. Adrenergic inhibiting drugs, diuretics, vasodilators, monoamine oxidase inhibitors, antiarrhythmics, hypolipidemics, and digitalis may affect the sexual response .

Question 26

anti epileptic drugs sex side effects

Answer 26

Women who were treated with lamotrigine initially or were switched to lamotrigine had a significantly improved change in sexual functioning . Gabapentin has been reported to induce orgasmic dysfunction . Topiramate has been reported to cause reversible anorgasmia

Question 27

alpha adrenergic drugs sex side effects

Answer 27

Clonidine and prazosin have been reported to reduce desire in women (wish for partner to approach them) in a small randomized trial. Clonidine has been shown to reduce subjective and physiological arousal in women as measured by a vaginal plethysmograph

Question 28

Which antidepressants have higher vs lower rates of sexual dysfunction side effects

Answer 28

Higher rates: Duloxetine and paroxetine, sertraline and fluoxetine. Lower: bupropion, moclobemide, nefazodone and reboxetine

Question 29

list antipsychotics whigh high and low rates of sexual dysfunction

Answer 29

May increase serum prolactin leading to hypogonadotrophic state. High: haloperidol (38.1%) and also with olanzapine (35.3%), quetiapine (18.2%), and risperidone (43.2%). Low: Olanzapine and quetiapine

Question 30

how does alcohol affect sexual function

Answer 30

acute alcohol intoxication decreases libido, interferes with arousal, leads to failure of erection and ejaculation, and impedes orgasm in women. Chronic alcohol leads to hypogonadotrophic state and loss of sexual function in men and women

Question 31

how does marijuana affect sexual function

Answer 31

inhibits orgasm, painful sex

Question 32

PDE5 inhibitors

Answer 32

*Inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. Sexual stimulation required to initiate release of NO, so no effect in absence of sex stimulation.

Question 33

List PD5 inhibitors

Answer 33

–Sildenafil, vardenafil,tadalafil

Question 34

Use of estrogen for sexual dysfunction

Answer 34

*high correlation between serum estradiol levels and sexual function in women. estrogens given by the oral or vaginal route significantly improved symptoms, dyspareunia, and vaginal pH

Question 35

use of antidepressants for sexual dysfunction

Answer 35

bupropion may have a beneficial effect on desire and orgasm in some women but it is not clear which women, or if the effect is independent of the antidepressant effect.

Question 36

What Is The Role Of Testosterone In Female Inhibited Sexual Desire

Answer 36

*Transdermal testosterone is more effective than placebo in treatment of hypoactive sexual desire disorder, but the effect is small. It is not FDA approved though

Question 37

Vaginismus treatment

Answer 37

Use dilators to learn to have something in vagina and confront fears. MUST involve partner