Sexual Counselling Flashcards
What are common presenting complaints?
- Inability to have sex
- Pain
- Lack of libido
- Difficulty with arousal
DDx for superficial dyspareunia?
Vaginal dryness - lack of arousal Infection Dermatology conditions Trauma Structural abnormalities Vulvodynia
DDx for deep dyspareunia?
Pelvic pathology - endometriosis
What is vulvodynia
Pain at the entroitis, typically burning, occurs in the absence of relevant visible findings or a specific, clinically, identifiable, neurologic disorder
Chronic pain condition - neuropathic
What is the pathophysiology of vulvodynia?
Chronic trauma > tissue change > nerve fibre proliferation > central sensitisation
How is vulvodynia diagnosed?
Q tip test
What is vaginismus?
Persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger or any object despite wanting to due to painful spasm of the pelvic floor muscles
- can be constant or reflex
What causes primary vaginismus?
"Fear of the unknown" "Common vaginal fears" - Getting damaged - tearing - Being damaged - Being too small Pregnancy Negative messages about sex Inability to trust others/self
What causes secondary vaginismus?
Previous pain inducing condition
- Eg candidiasis
How is vaginismus mx?
Stop trying intercourse Counselling - Reassure they're not the only one - Education Refer - Assessment - Physical management - Physio relaxation
How do you manage vulvodynia?
Simple skin care Medications - TCA - Anti-convulsants General pain meds
How do you assess lack of desire?
Is it really a lack of desire
Level of lack of desire (initiatory or responsive)
?Desire discrepancy
How do you manage sexual dysfunction?
PLISSIT mode
- Permission
- Limited Information
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