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3a sexual health > Sexual disorders > Flashcards

Sexual disorders Flashcards

1
Q

List general physical causes of sexual health disorders

A
  1. chronic disease e.g. diabetes, obesity, neurological disorders, cardiovascular disease
  2. hormone disorders e.g. hyperprolactinaemia, thyroid dysfunction, oestrogen/androgen deficiency
  3. local problems e.g. infections (STI), insufficient lube, irritation (thrush), congenital defects, tumour, cyst
  4. FGM
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2
Q

List general psychosexual causes of sexual health disorders

A 
stress, depression, anxiety
past trauma or abuse 
alcohol use / illicit drugs e.g. cocaine
relationship problems e.g. sexual script 
low self esteem/ poor body image 
FGM
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3
Q

List general iatrogenic causes of sexual health disorders

A

SSRIs

anti hypertensives e.g. beta blockers -> ED, alpha blockers -> retrograde ejaculation

local damage from surgery e.g. prostate surgery -> ED

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4
Q

List behavioural interventions for sexual health disorders

A

stop start technique
sexual aids
vacuum device/ Eros device
guided self exploration

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5
Q

What are the 4 types of psychosexual therapy used in sexual health disorders?

A
  1. CBT
  2. psychodynamic therapy
  3. systemic therapy
  4. integrative therapy
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6
Q

What are the 5 key principles of couples therapy?

A
  1. improve communication
  2. modify dysfunctional behaviour
  3. decrease emotional avoidance
  4. change view of relationship
  5. promote strengths
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7
Q

What is included in a hormone blood test?

A
  1. testosterone + SHBG + albumin
  2. oestrogen
  3. prolactin
  4. thyroid function
  5. progesterone
  6. free androgen index
  7. LSH /FH
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8
Q

Describe the aim of CBT?

A

focuses on dysfunctional patterns of belief and behaviour in the HERE AND NOW

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9
Q

Describe the principles of psychodynamic therapy

A

focuses on current problems and earlier patterns of response and behaviour from the past

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10
Q

Describe systemic therapy principles

A

focuses on process and context and content to bring about change

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11
Q

Describe integrative therapy principles

A

uses understanding and interventions from more than one approach

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12
Q

Define male hypoactive sexual desire disorder

A

the lack/loss of sexual desire and persistent deficient sexual/erotic thoughts or fantasies about sex

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13
Q

How is male hypoactive sexual desire disorder managed?

A
  1. treat the cause!!

2. individual psychosexual therapy

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14
Q

Define sexual aversion disorder

A

complete distaste and fear of sex

discussing sex is intolerable and distressing

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15
Q

Define erectile dysfunction

A

difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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16
Q

List the causes of erectile dysfunction

A 
PHYSICAL
chronic medical conditions
hormonal disorders
age related 
veno-occlusive disorder 
PSYCHOSOCIAL
performance anxiety, negative previous experiences
couple script problems 
sex education 
depression, substance misuse

IATROGENIC
beta blockers, SSRIs, post prostate surgery

17
Q

Which medication can be prescribed for erectile dysfunction

A

1st line = oral PDE5 inhibitors e.g. sildenafil, avanafil, tadalafil

2nd line = injectable alprostadil - takes 45-60 mins to become effective

18
Q

Describe the mechanism of PDE5 inhibitors

A

phosphodiesterase type 5 inhibitors cause vasodilation in the penis

PDE5 inhibitors block the breakdown of cGMP causing prolonged action of vasodilators e.g. nitric oxide

this causes increased blood flow to the penis to cause an erection

19
Q

List the side effects of PDE5 inhibitors

A 
headache
flushing
dizziness 
hypotension
stomach pain 
indigestion
20
Q

Outline the non-medical options to manage erectile dysfunction

A

vacuum device
penile/scrotal rings
kegel exercises
new stimulating routines e.g. lubricants, vibrators

21
Q

define female sexual arousal disorder

A

recurrent or persistent inability to attain sexual arousal or to maintain arousal until completion of sexual activity

22
Q

Outline DSM-5 features of female sexual arousal disorder

A

NEED >3 FOR DIAGNOSIS

  1. reduced interest in sexual activity
  2. reduced sexual/ erotic thoughts or fantasises
  3. reduced/ no initiation of sexual activity and typically inceptive to a partners attempts to initiate
  4. reduced sexual excitement/pleasure during sexual activity
  5. reduce sexual arousal in response to any internal or external sexual cues
  6. reduce genital/non genital sensations during sexual activity
23
Q

How is female sexual arousal disorder managed?

A
  1. treat the cause! correct hormone issues
  2. couples psychosexual therapy **
  3. behavioural - eros device, sexual aids, sensate focus
24
Q

define female orgasmic disorder

A

marked delay, marked infrequency or absence of orgasms

25
Q

How can menopause affect sexual function?

A 
vaginal dryness 
vaginal pain / pelvic pain
change in libido
change in mood, self image, cognition
physical discomfort - sleeplessness, nigh sweats 
relationship problems
26
Q

Define rapid ejaculation

A

the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction

approx 1 min following vaginal penetration and before the person wishes

27
Q

List the possible causes of rapid ejaculation

A 
PHYSICAL
penile hypersensitivity 
hyperthyroidism
prostatitis 
comorbid sexual health problems e.g. ED

PSYHCOSOCIAL
anxiety
lack of experience, infrequent sexual activity
relationship issues

28
Q

Which medication can be used for rapid ejaculation?

A

topical local anaesthetic

29
Q

Define delayed ejaculation

A

marked delay, infrequent or absence in ejaculation

30
Q

Outline the possible causes of delayed ejaculation

A

PHYSICAL
neurological disorders e.g. spinal cord injury, neuropathy
trauma, surgery
medication e.g. SSRI, alpha blockers, alcohol
low testosterone levels

PSYCHOSOCIAL
insufficient stimulation
poor body image 
relationship factors
poor sexual arousal
31
Q

What is important to exclude with a possible diagnosis of delayed ejaculation

A

retrograde ejaculation as can be a cause of infertility!

32
Q

Which sexual health disorder is an indication to do a physical examination?

A

vaginismus

33
Q

Define vaginismus

A

spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening

34
Q

how does vaginismus present?

A

persistent/ recurrent difficulties with >1 of the following..

  1. vaginal penetration during intercourse
  2. vulvovaginal/ pelvic pain during intercourse
  3. fear/anxiety about pain during/ anticipation of vaginal penetration
  4. tensing or tightening go the pelvic floor muscles during attempted penetration
35
Q

What are the causes of vaginismus?

A

PHYSICAL
vaginal conditions causing soreness
FGM
congenital abnormality

PSYCHOSOCIAL
religious /cultural issues
fear of pregnancy
fear/dislike of partner 
previous sexual abuse/ trauma 
situational
36
Q

How is vaginismus managed?

A
  1. treat cause!
  2. individual psychosexual therapy
  3. behavioural interventions - self exploration, kegel exercises, vaginal dilators
37
Q

Define dyspareunia

A

pain during intercourse

38
Q

List the causes of superficial dyspareunia

A 
episiotomy 
recurrent infections e.g. herpes
bartholins cyst 
urethritis 
menopause 
post radiotherapy
insufficient lube / sexual arousal
39
Q

List the causes of deep dyspareunia

A 
endometriosis 
pelvic tumours
fibroids
surgical adhesions
PID
constipation
irritable bowel syndrome

3a sexual health (3 decks)

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