Sexual disorders Flashcards
What is Sexual Dysfunction?
a disturbance in one or
more phases of the sexual response cycle
* Problems can arise from underlying health issues,
surgical treatment, side effects of medication,
communication difficulties, and
misunderstandings
Sexual dysfunction is positively correlated with
____
low relationship satisfaction and general
happiness
Five areas to address with patients who present with sexual problems:
❑Explicit symptoms or questions the patient is having
❑Onset and course of symptoms
❑Patient’s perception of the cause and maintenance of the problem
❑Medical evaluation, including medical history, past treatment, and outcome
❑ Specifically exclude chronic health problems
❑ Diabetes, cardiovascular disease, hyperlipidemia, hypertension, past or current history of cancer
❑Current expectations and goals for treatment
Medical Conditions & Treatments that effect sexual performance
- Arthritis, bone/joint disease
- Diabetes mellitus
- Endocrine problems
- Injury to autonomic nervous system by surgery or radiation
- Liver or renal failure
- Vascular Disease
- Mood disorders
- Including depression, anxiety, and panic
- Multiple Sclerosis
- Peripheral Neuropathy
- Radical pelvic surgery
- Respiratory disorders such as COPD
- Spinal cord Injury
Symptom patterns that suggest a primarily organic etiology of sexual dysfunction
Generalized
* Absent desire, erectile problems, rapid ejaculation,
painful intercourse
* Gradual Onset
* Rapid onset when associated with certain medication
Symptom patterns suggestive of primarily psychological etiology of sexual dysfunction
- Situational
- Rapid onset
- Unless medication is suspected
- Sexual phobia or aversion
Pharmaceuticals that Cause
Sexual Dysfunction
Alcohol
* Anticancer drugs and hormones
* Anticonvulsants
* Antihypertensives
* Including beta blockers (at high dosages), excluding ACE inhibitors
* Carbonic anhydrase inhibitors
* Cytotoxic drugs
* Diuretics
* H2 Receptor antagonists
* Nonsteroidal anti-inflammatory agents
* Prescribed Opiates
* Pain medications
* Psychedelic and hallucinogenic drugs
* Psychotic medications
* Benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, SSRIs, antipsychotics, lithium carbonate
* Recreational drugs
* Tobacco, alcohol, opiates
* Sleep medication
* Tranquilizers
The following medications may cause erectile dysfunction:
- Anti-hypertensive medications (used to treat high blood pressure)
Sexual Desire Disorders etiology
hypothyroidism, hyperprolactinemia,
hypogonadism, or substances like SSRIs, antipsychotic medication, drugs, or alcohol
* Loss of interest in sexual interaction with self or others can be primary, secondary, generalized, or situational in occurrence
Clinical presentation of Sexual Desire Disorders
It’s common for partners to present with different levels of sexual desire
* Extreme aversion can cause complete avoidance of genital or sexual contact with partner
* Persistent or recurrently absent sexual or erotic thoughts or fantasies and sexual desire for sexual activity for at least 6 months
Sexual Desire Disorders diagnosis
Patient interview, Laboratory testing for
testosterone, prolactin, TSH levels
Sexual Desire Disorders management
- Bupropion increases sexual responsiveness in women
- Hormone replacement therapy
- Behavioral sex therapy
Potential complications of Sexual Desire Disorders
Bupropion can lower the seizure
threshold
* Possible destabilization of the patient’s relationship by altering one
partners desire
* Side effects/risks of hormone therapy
Sexual Arousal Disorders etiology
Most likely a result of organic and
psychologic etiologies. Vascular problems, nerve
damage, and hormonal imbalances are common
causes of organic etiologies. Depression, social
anxiety, and post traumatic stress disorder are
associated with ED
_____ is a mental and physical dysfunctional state in which women lack motivation for or lose desire to have sex for an extended period of time (at least 6 months)
Hypoactive Sexual Desire Disorder
Symptoms of Hypoactive Sexual Desire Disorder
- decreased spontaneous sexual thoughts/fantasies,
- decreased responsiveness to stimulation,
- inability to maintain interest during sex, and
- loss of desire to initiate sex
Avoidant behaviors: Women may avoid situations that
could lead to sexual activity
Sexual Arousal Disorders diagnostic eval
Obtain detailed information regarding
onset, duration, progression, severity, and associated medical conditions
* Physical exam should be guided by this history
* Assess for overall health, lifestyle (exercise, tobacco, alcohol
use), assess for cardiovascular, neurologic, or hormonal
etiologies
* Labs: Serum prolactin level, fasting glucose, lipids, thyroid function
Sexual Arousal Disorders management
Modify lifestyle
* Increase physical activity, weight loss, smoking cessation, diet
changes, DM control, treat hypertension, treat depression
* Psychological therapy with sexual homework assignments, modify
unrealistic expectations, couples therapy
* Vascular microsurgery, penile prosthesis
* FDA approved pharmacologic therapy for premenopausal women:
Addyi (fibanserin), Vyleesi (bremelanotide)
* For persistent female genital arousal patients may try ice, pelvic
massage, stretching, SNRIs, and/or anesthetizing agents
* Potential complications: priapism, facial flushing, nasal stuffiness,
visual disturbances, syncope
Orgasm Disorders etiology
Difficulty achieving orgasm can stem from
diminished orgasmic sensation, age, or type/lack of sexual experience
Orgasm Disorders presentation
Patient reports of being unable to
orgasm
Orgasm Disorders management
Evaluate and treat for desire or
arousal problem (or relationship problem) if a
woman was orgasmic and then is unable to
achieve orgasm
* Hypoactive Sexual Desire Disorder (HSDD) – medications, sex therapy, address other co-morbidities
Sexual Pain Disorders etiology
vaginal infections, vaginitis, vestibulitis (a
stinging/burning like pain at the vaginal introitus),
abnormal pelvic pathology, vaginismus, and
inadequate vaginal lubrication can cause sexual
discomfort.
Sexual Pain Disorders presentation
Women express recurrent
difficulty with:
* Vaginal penetration during intercourse
* Vulvovaginal or pelvic pain during intercourse
* Anxiety or fear of pelvic pain in anticipation of
intercourse
* Tensing or tightening the pelvic floor muscles during attempted vaginal penetration
Sexual Pain Disorders diagnostic eval
Vaginal exam, STD testing,
taking a detailed history of onset, location,
duration, etc
