Sex Med Flashcards
What is the presentation of HIV?
Opportunistic infections: - oral candidiasis - TB - Pneumonia -
How do you diagnose HIV?
blood: ELISA antibodies
Saliva sample
How do you monitor HIV?
T4 viral load count
HIV viral load (RNA copies)
How do you prevent HIV?
Post or Pre Exposure Prophylaxis
PEP or PrEP
Reverse enzyme transcriptase
How do you treat HIV?
HAART
Highly Active Antiretroviral Therapy
What blood tests would you want to do in assessment of sexual problems?
Fasting glucose Lipid profile TSH SHBG, testosterone, albumin Prolactin Oestrogen FBC
What chronic medical conditions can cause hypoactive sexual desire disorders?
Obesity
CVD
Diabetes mellitus
Anaemia
Hormonal:
- androgen deficiency
- hyperprolactinaemia
- hypothyroidism
What psychological conditions can cause hypoactive sexual desire disorders?
Depression Anxiety PTSD Substance misuse Stress Body image disorder
How should you approach a sexual disorder assessment?
Consider: Bio, Psycho and Social factors
Consider: Predisposing, Precipitating and Maintaining factors
What are social conditions/factors can cause hypoactive sexual desire disorder?
Body image disorder Life stressors- e.g. work Previous trauma or abuse Couple script problems Erotic dissatisfaction Couple relationship problems
What are psychosexual treatment options for hypoactive sexual desire disorders?
CBT Psychodynamic psychotherapy Individual psychosexual therapy Sexual growth programme Couples therapy Family therapy
What are medical treatment options for hypoactive sexual desire disorders?
Testosterone replacements (injection, transdermal patches, gel, buccal)
What are the medical causes of erectile disorder?
CVD, obesity, diabetes mellitus, neurological disease (nerve damage, MS, autonomic damage), alcoholism
Androgen deficiency, hyperprolactinaemia
Age related changes
What are iatrogenic causes of hypoactive sexual desire disorder?
Medication: SSRIs, COCP, HRT, anti-psychotics, b-blockers
Orchidectomy/ oophrectomy
What are psychological causes of erectile disorder?
Depression, anxiety, substance misuse
Performance anxiety
What are iatrogenic causes of erectile disorder?
prostate surgery
SSRIs
Antihypertensives
What are social causes of erectile disorder?
Couples script problems
Relationship problems
Cultural or religious issues
What are the medical management options for erectile dysfunction?
Sildenafil (viagra)
What are the non-medical management options for erectile dysfunction?
Vacuum device Penile/ scrotal rings Enhancing lubes Vibrators Kegel exercises
What are medical conditions that cause female arousal disorder?
CVD, Obesity, Diabetes mellitus, chronic fatigue syndrome
Hypothyroidism, post-menopausal, breast feeding
What are iatrogenic causes of female arousal disorder?
SSRIs
HRT
Oophrectomy
What are psychological causes of female arousal disorder?
Depression
Anxiety
Eating disorders
PTSD (abuse)
What are social causes of female arousal disorder?
Couple script problems Body image disorders Life stressors e.g. work Previous trauma or abuse Couples relationship problems
What is the management for female arousal disorder?
Psychological:
CBT, psychodynamic psychotherapy, sexual growth programme, individual/ couple psychosexual therapy
Behavioural:
Sensate focus
Tools:
Lubricants
Vibrators
Eros
What are the physiological and iatrogenic causes of female orgasm disorder?
Obesity, CVD, Diabetes mellitus
Oestrogen/ androgen insufficiency (e.g. post menopausal)
Hypothyroidism
Pelvic floor weakness
SSRIs
What are the psychological causes of female orgasm disorder?
Depression, anxiety, substance misuse
PTSD
What are the social causes of female orgasm disorder?
Couple script problems Couple relationship problems Previous abuse Cultural and religious issues Life stressors- e.g. work Environmental
How does menopause effect sexual function?
Vaginal atrophy
Vaginal dryness
Reduced oestrogen and androgens
Change in self image- psychosocial effects of menopause
What are the 4 types of relationship therapy?
Cognitive behavioural
Psychodynamic
Systemic
Integrative
What are the physiological causes of rapid ejaculation?
Genetic neuroreceptor sensitivity Penile hypersensitivity Hyperthyroidism Prostatitis Other sexual problems (e.g. ED)
What are the psychological causes of rapid ejaculation?
Anxiety
What are the social causes of rapid ejaculation?
Early learned experiences Lack of sexual experiences Infrequent sexual activity Relationship issues Partner issues e.g. pain
What is the management of rapid ejaculation?
Topical anaesthetics
SSRI
Couple psychosexual therapy
Behavioural interventions: sensate focus, stop start techniques, mindfulness
What are the physiological causes of delayed ejaculation?
Trauma/ surgery Age Infectious disorders Diabetes mellitus Spinal cord injury Alcoholic neuropathy Low testosterone
SSRIs
Thiazides
What are psychological causes of delayed ejaculation?
depression anxiety Poor arousal Poor body image PTSD (abuse) *** ? retrograde ejaculation ***
What are the social causes of delayed ejaculation?
Body image issues
Partner issues e.g. pain
What investigations would you do in delayed ejaculation?
Physical examination
Blood tests: FBC, glucose, testosterone, B12/folate, PSA
Urine sample (retrograde ejaculation)
What are is the management for delayed ejaculation?
Sexual growth programme
Individual or couples therapy
Kegel exercises
Use of vibrators
What is vaginismus?
Spasm of the pelvic floor muscles that surround the vagina, occluding the opening
Resulting in impossible or painful penile entry
What are the causes of vaginismus?
Physiological; Vulval infection (e.g. thrush), imperforate hymen, FGM
Anxiety, religious of cultural issues, previous abuse/trauma/ negative experience, relationship issues
What is the management of vaginismus?
Treat any infections of structural abnormalities
Individual psychosexual therapy, sexual growth programme, CBT, mindfulness, breathing control, kegel exercises, vaginal trainers
What is dyspareunia?
Pain during intercourse
What are the causes of dyspareunia?
Infection/ injury/ hypersensitivity Endometriosis IBS constipation Bartholin's cyst STDs
Previous abuse/ trauma
Anxiety
Partner: poor technique/timing/speed
intimacy issues
Disliking partner
What is the management for dyspareunia?
Manage any infection
Couple therapy: CBT, psychodynamic, systemic, integrative
Sexual growth programme
What are the stages of sexual response?
- desire
- arousal
- orgasm
- resolution
What is Peyronie’s disease?
+ what are the subsequent sexual problems?
fibrous plaque in the corpus cavernosum (tunica albuginea) on the penis causing a curvature
Painful sex
Difficult sex
Body image issues
Partner problems: dissatisfaction, pain
What is the management of Peyronie’s disease?
Surgical correction
Vacuum pump
Can self resolve
What does sex, gender identity and gender expression mean?
Sex: assigned, karyotype/ phenotype
Gender identity: Personal intrinsic sense of self
Gender expression: Personality, appearance and behaviour- fits into social and cultural norms
What is gender dysphoria?
DISTRESS due to misalignment of sex and gender identity
What is transgender
and
What is transexual?
Transgender- diverse gender variance
Transexual- seeking to change or changing primary or sexondary sex characteristics
What is the management for trans MtF?
Medical:
- Oestrogen supplements
- Anti-androgens
- Fertility management
Psychosocial:
- Social transition support
- Psychotherapy
- Speech therapy (feminisation)
Surgical:
- Vulvoplasty/ vaginoplasty
- Mammoplasty (breast implants)
- Facial feminisation surgery
Other:
- facial hair removal
What is the management for trans FtM?
Medical:
- Testosterone supplements
- GNrH analogues (to abolish menstrual cycle?)
- Fertility management
Psychosocial:
- Social transition support
- Psychotherapy
- Speech therapy
Surgical:
- Phalloplasty
- Hysterectomy/ oophrectomy
- Mastectomy
