Sex physiology and dysfunction Flashcards
What is hypoactive sexual desire disorder? (HSDD)
what gender does it affect only?
6+ months of low sex desire, low sex cue response, low initiation of sex (is arousable + cam ejaculate)
Female only
RF for hypoactive sexual desire disorder? (HSDD)
Mood (depression, anxiety)
Endocrine (DM)
Meds (opioids, SSRI)
RS problems incl abuse and trauma
What hormones/drugs stimulate sex and inhibit it?
Dx of HSDD?
sex stimulation = DA and melanocortin
sex inhibition = 5HT + Opioids
bloods + Hx
Tx for hypoactive sexual desire disorder? (HSDD)
Flibanserin (<menopause) + Bremelanotide
stop stress, stop meds, exercise, couples therapy
What can you not do when taking Flibanserin and why?
drinking alcohol <2hr = SE hypotension
What is anorgasmia?
what gender does it only affect?
6+ moths failure to orgasm despite adequate stimulation (lifelong, acquired, situational) - absence, delay, decreased intensity and decreased frequency
Female only
Causes of anorgasmia?
Mood
DM + Low T4
post menopausal
post hysterectomy
stress including Eating disorders
abuse
dyspareunia
SSRI
Dx and Tx of anorgasmia?
Dx = bloods
Tx = clitoral vacuum, COCP, Sexual education (eg. clitoral stimulation + direct orgasm Tx), couples therapy
What is vaginismus?
what can this result in?
Involuntary contractions of vagial wall muscle (spasm) - doesn’t allow penetration
Sex avoided sue to pain, big effect on couples
RF of vaginismus?
anxiety
trauma
surgeries
childbirth
FGM
Sx of vaginismus?
problematic sex
can’t do Pap smears
can’t insert IUS/IUD
Tx for vaginismus?
sex education
Kegel exercise (PT) + Vaginal dilation therapy
+ sex psychology input (couples therapy, diff sex techniques)
What is vulvodynia?
3+ months vulval pain, provoked (with touching..) or unprovoked
1^ or 2^ to lesion
+ve swab test (burning when touched)
Tx of vulvodynia?
low friction
keigel
analgesia (simple, last line = TCA)
Tx is vestibulodynia?
consider vestibulectomy
what is erectile dysfunction?
6+ months impotence
Causes of erectile dysfunction?
PVD!!
DM
Spinal cord compression
hyperPRL
stress + mood
MS
Dx of erectile Dysfunction?
bloods
QRISK3
ABPI
Tx of erectile Dysfunction?
Keigel PT
Sildenafil
Penile ring
penile vacuum
what is premature ejaculation?
less than 1 minute sex +/- penetration (before Px wants it)
>6 months
Causes of premature ejaculation?
Dx?
performance anxiety
watching pornography
hyperT4
sex abuse
Sex bloods
Tx of premature ejaculation?
lower performance anxiety - stop start squeeze = 54321 breathing technique
Kegel (PT)
Dapoxetine (SSRI)
Local anaesthesia eg. lidocaine cream
What is retrograde ejaculation?
causes?
dry orgasm
TURP (Transurethral resection of prostate)
Ace-i/BB
Alpha-B
Dx and Tx of retrograde ejaculation?
post ejaculatory void - high sperm
none
causes of anejaculation?
Mental health = depressed, stress, new partner, divorce
Endocrine = DM, Low testosterone
Neuro = parkinsons, MS, Nerve damage (TURP)
Drug = SSRI, Alpha blockers
Tx of anejaculation?
Sex stimulation education
CBT
Couples therapy
What is peyronie?
T3 Collagen deposits in tunica albuginea, results in deformed shaped penis with abnormal fixed erection
What is peyronie associated with?
HLA DR5 + Dupuytrens
Dx of peyronie?
penile USS - Hyperechogenic fibrotic plaques
Tx of peyronie?
Surgery = plications (straightening)
Intrapenile injections (colleganase)
