Sexual

Question 1

name the pharmacological treatment for women with hypoactive sexual desire disorder

Answer 1

flibaserin

Question 2

define sexual desire disorder

Answer 2

lack of desire for sex leading to distress

Question 3

what is sildenafil?

Answer 3

phosphodiesterase 5 inhibitor

Question 4

define paraphilia

Answer 4

sexual response from non sexual stimuli

Question 5

define rapid ejaculation

Answer 5

ejaculation occuring too quickly for both partners to enjoy intercourse or within one minute

Question 6

which investigations should be done in someone with a sexual desire disorder?

Answer 6

TFT, lipids, glucose, testosterone, SHBG, oestrogen, prolactin

Question 7

which condition do you use flibanserin for?

Answer 7

female hypoactive sexual desire disorder, not arousal

Question 8

what causes sexual disorders

Answer 8

bio-hyperprolactinaemia, low androgens, DM, CVD, thyroid disorders, neuro, SSRIs
psych-previous abuse, depression, body image
social-performance anxiety, relationship troubles, stress

Question 9

how should you manage a woman with dyspareunia?

Answer 9

swabs
consider gynae causes-cysts/endometriosis
consider referral to psychosexual therapy

Question 10

name what bacteria BV can be caused by?

Answer 10

lactobacilli

gardenerella vaginosis

Question 11

give 2 antibiotic regimens used for chlamydia

Answer 11

1d azithromycin

7d doxycycline

Question 12

what are the symptoms of secondary syphilis?

Answer 12

fever, headache, myalgia
rash on palms and soles
mucous patches
rash-condylomata lata
lymphadenopathy

Question 13

how is syphilis diagnosed

Answer 13

PCR blood

Question 14

when does secondary syphilis resolve?

Answer 14

about 14 weeks later, then tertiary comes on 20-40 years later

Question 15

herpes symptoms

Answer 15

flu like prodrome
myalgia
painful ulcers

Question 16

can someone with active herpes have sex?

Answer 16

no-condoms aren’t very effective

Question 17

which strains of hepatitis are transmitted sexually?

Answer 17

B and C

Question 18

what should you think of when diagnosing someone with thrush

Answer 18

HIV and DM

Question 19

treatment of chlamydia?

Answer 19

1d azithromycin or 7d doxycycline

Question 20

asymptomatic screening methods?

Answer 20

NAAT of: endocervical swab or first pass urine

Question 21

physical causes of sexual problems?

Answer 21

chronic diseases: DM, CVD, obesity, neuro
hormone: thyroid dysfunction, hyperprolactin, androgen deficiency
local-infection, irritation, congenital defect, endometriosis, tumour, cyst, FGM

Question 22

psychological causes of sexual problems?

Answer 22

stress depression anxiety
low self esteem
trauma or abuse

Question 23

iatrogenic causes of sexual problems?

Answer 23

SSRIs>low libido
beta blockers>ED
alpha blockers>reterograde ejaculation and so infertility
local damage from surgery-prostate surgery can lead to ED

Question 24

treatment for ED?

Answer 24

pharm is 1st line-either sildenafil or alproprostadil-have to be taken 45 min before sex
then ring, Kegel’s, vaccuum

Question 25

what are the 6 features of female sexual arousal disorder?

Answer 25

``` little interest in sex few thoughts about sex decreased initiation of sex little pleasure during sex decreased interest in sex when exposed to erotic stimuli little physical response to sex ```

Question 26

what different types of psychosexual therapy are there?

Answer 26

``` CBT-how they think now psychodynamic-looking at problems in past and how that can be changed now systemic-looking at problem as a whole couples integrative-using different types ```

Question 27

what are the 5 key principles of couples therapy?

Answer 27

``` improve communication modify dysfunctional behaviour decrease emotional avoidance change view of relationship promote strengths ```

Question 28

what does the asymptomatic STI screen look for?

Answer 28

chlamydia, gonorrhoea NAAT HIV and syphilis blood test add on hep b and c if high risk

Question 29

what puts someone at high risk of hepatitis?

Answer 29

IVDU, high risk country, MSM, sex workers

Question 30

what does the symptomatic screen look for

Answer 30

everything in asymptomatic as well as high vaginal swabs as well as urethral and pharangeal and rectal swabs, urinalysis depending on exposures

Question 31

give an example of primary prevention strategies in sexual health

Answer 31

reduce risk of acquiring so: education, awareness, free condoms, hep b vaccination

Question 32

why might a sexual health screen give inaccurate results?

Answer 32

poor technique | not past the 2 week window from exposure

Question 33

what are the features of trichomonas?

Answer 33

strawberry cervix and fishy grey discharge

Question 34

what are the risks of STIs in pregnancy?

Answer 34

chlamydia>low birthweight PPROM | gonorrhoea>opthalmis neonatorum, premature labour, miscarriage, PID

Question 35

what advice should be given to those prescribed metronidazole?

Answer 35

don't drink!

Question 36

when will warts manifest?

Answer 36

immunosuppression as with pregnancy, age , DM, steroids

Question 37

how do you differentiate between BV and other diseases?

Answer 37

whiff test-put KOH on speculum (it is alkaline and BV is very acidic so this releases volitile amines)

Question 38

what are the causes of vaginismus

Answer 38

thrush FGM psychiatric

Question 39

define hypoactive sexual desire disorder

Answer 39

lack of desire for sex

Question 40

how do you differentiate between physical and psychiatric causes of ED?

Answer 40

psychiatric still have early morning erections, biological just cannot

Question 41

what is the definition of delayed orgasm?

Answer 41

occuring later than patient wants-it has to follow normal arousal

Question 42

how is NAAT taken in men?

Answer 42

first void

Question 43

how is herpes tested for?

Answer 43

PCR swab

Question 44

how is chlamydia different?

Answer 44

obligate intracellular gram negative bacteria

Question 45

give complications of chlamydia

Answer 45

lymphogranuloma venerum PROM low birthweight Reiter's

Question 46

what are clue cells

Answer 46

vaginal epithelial cells covered in bacteria

Question 47

drugs that can cause delayed ejaculation

Answer 47

``` SSRI antipsychotics BB baclofen opiates ```

Question 48

causes of ED

Answer 48

DM, hyperprolactinaemia, hypogonadism, PVD, veno occlusive disease, kidney failure SSRI

Question 49

vaginismus causes

Answer 49

organic-thrush, FGM, trauma, congenital abnormality | psychological-fear/dislike of partner, mistaken beliefs

Question 50

what disorder would you use integrated CBT for?

Answer 50

vaginismus