Sexual Dysfunction Flashcards
Spinal regions and their interaction with genital experiences
Sympathetic outflow
- psychogenic erection
Parasympathetic
- reflexogenic erection
Somatic
- penile sensations
- IC/ BC contractions
Spinal cord lesions and how they in impact genitalia
- impaired genital sensations
- loss of erectile functions
- reduced vaginal lubrication
- loss of ejaculation
Above T11
- loss of psychogenic erection
- 30-70% ejaculation
T11-S2
- both reflexogenic and psychogenic erection in tact
- ejaculation 3-70% (<5% if L4 lesion)
Sacral/ infrasacral
- loss of reflexogenic erection
- 50-67% ejaculation (dribbling)
Types of sexual dysfunction
- Libido, sexual desire
- Genital arousal
- Orgasm/ ejaculation
- Sexual pain
- M/F symptoms
M — reduced/ absent sexual desire, interest or motivation - M/F symptoms
M — erectile dysfunction
F - vaginal dryness, reduced vaginal lubrication - M/F symptoms
M — reduced, delayed or absent orgasm. Delayed, absent or ornate ejaculation.
F — reduced, delayed or absent orgasm - M/F symptoms
F — dyspareunia, vaginismus
A multidimensional approach to sexual dysfunction
Primary
- neurological lesion-sensations
- arousal
- ejaculation
Secondary
- fatigue
- bladder/ bowel incontinence
- spasticity, spasms, weakness
- in coordination, tremor
Tertiary
- depression, anxiety
- anger, guilt, fear
- self esteem and body image
- family role change, relationship with partner
Consider other causes an treat accordingly
- cardiovascular
- endocrine
- psychogenic
- urogenital disease
What are the management and treatment options for sexual dysfunctions
- penile rings
- vacuum pump
- touch and mindfulness
- individual or couples therapy
- education
- injections (Caverject)
First line of erectile dysfunction
(Pharmalogical)
Phosphodiesterase 5 inhibitors
Sildenafil - viagra
(4 hr effect)
Vardenafil - levitra
(4 hr effect)
Tadalafil - Cialis
(36hr effect)
