Sexual Disorders and treatments Flashcards
What are the hormonal tests done in sexual health disorders?
Testosterone Oestrogen Progesterone Prolactin Thyroid Function Free Androgen Index (fAi) LH FSH Albumin
What other blood tests are done in sexual disorders?q
CV screen- FBC, lipids, glucose
STI screen
What are physical causes of sexual disorders?
Chronic disease- CV disease, diabetes, obesity, neurological disorders
Hormone disorders- androgen or oestrogen deficiency, hyperprolatineamia, thyroid dysfunction
Local issues- prostatitis, dryness, congenital defects, atrophy after menopause, endometriosis, tumours and cysts, FGM
What are the psychological causes of sexual disorders?
Stress Depression Anxiety Past trauma Abuse Relationship 'script' issues Lack of education Illicit drugs Alcohol abuse
What are the iatrogenic causes of sexual dysfunction?
SSRIs
Antihypertensives (BBs cause erectile dysfuction, alpha blockers cause retrograde ejaculation)
Local damage from surgery
What is Female Orgasmic Disorder, what are implications and what can you treat with?
Delayed or absent Orgasm
“Spectatoring” or chasing an orgasm so much doesnt enjoy sex.
Rx- Bloods, physical exam for abnormality, topical oestrogen
What is Sexual Aversion Disorder & how do you treat it?
Complete fear or distaste for sex and talking about it
Treatment is psychological therapy
What is hypoactive sexual desire disorder?
Lack of libido, little interest in sex Few thoughts about sex Decreased initiation of sex Decreased pleasure during sex Little interest when exposed to erotic stimuli Little physical response to sex
What causes Hypoactive Sexual Desire Disorder in men?
Chronic disease: CVD, DM, psychological, anaemia, obesity
Hormonal- androgen deficiency, hypogonadism, hyperprolactinaemia
Iatrogenic: SSRIs, Finasteride (hair loss treatment), Ochidectomy
Psychological: Body image issues, Depression, Stress, Erotic dissatisfaction, script issues
Treat by cause- CBT, Psychological therapy, self exploration and Testosterone
What are causes of Erectile Dysfunction?
CVD DM Neurological disease Low Testosterone SSRIs Beta Blockers Prostate Surgery Inaffective sexual stimuli Psychological and relationship issues Hyperprolactinaemia Age Veno-occlusive disorder Performance anxiety Education
What are potential treatments for Erectile Dysfunction?
Non medical and Medical
Non Medical: Vacuum device and penile ring Kegel's exercises Psychological therapy Medical: VASODILATORS Sildenafil orally Injectable Alprostadil Intraurethral Pellet Alprostadil (Take 40-60 mins to work, best on an empty stomach, cause headache and need sufficient stimulation)
What causes Hypoactive Sexual Desire Disorder in women? And how is it treated
Chronic disease: CVD, DM, psychological, anaemia, obesity, local irritation
Hormonal: Hypothyroid, Addisons and past pregnancy too, oestrogen deficiency, lactation due to prolactin
Iatrogenic: OCP, HRT, antipsychotics, Beta blockers and oophrectomy, SSRIs
Psychological: Body image issues, Depression, Stress, Erotic dissatisfaction, script issues
Treat by cause CBT, Psychological therapy, self exploration, sexual aids, correct any hormonal issues and TESTOSTERONE
How can testosterone be administered?
IM- but addictive a bit due to the 'high' Transdermal patch/gel Buccal Implant Alternatively give hCG
DO repeat tests
Side effects of testosterone in men
Enlarged breasts Prolonged erections. Excess hair growth. Male pattern of baldness. Skin rash. Acne. Water retention. Nausea Prostate swelling Decrease sperm count Decreased testicle size
Side effects of testosterone in women
Menstrual irregularity or absence of periods. Excess body hair. Hair growth on chin or upper lip (hirsutism) Acne. Enlarged clitoris. Balding, especially around the hairline. Increased muscle mass. Changes in body shape.
