Sexual dysfunction Flashcards
Sexual aversion disorder
a) What is it?
b) What does it lead to?
a) Persistent or recurrent extreme aversion to and avoidance of all or almost all genital sexual contact with a sexual partner.
b) Marked distress or interpersonal difficulty.
Male hypoactive sexual desire disorder
a) What is it?
b) What does it lead to?
a) Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. Less likely to initiate sex but may still enjoy intercourse
b) Marked distress or interpersonal difficulty
Female sexual arousal disorder
a) Principal feature
b) Also has reduced or absent…? (RIPE)
a) Failure of genital response: principle problem is vaginal dryness/lack of lubrication
b) Reduced or absent: • Responsiveness • Interest in sexual activity • Pleasure • Erotic thoughts
Erectile dysfunction: presentation
a) Define
b) Causes (HARP ON)
c) Drugs causes (Rx)
a) Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
b) Causes:
H - Hormonal (thyroid, hypogonadism, hyperprolactin)
A - Anatomical (Peyronie’s, micropenis)
R - Rx (lots)
P - Psychogenic (intimacy, psychological, psych Dx, etc)
O - Organic (CVD and CV risk factors, trauma)
N - Neurological (central and peripheral NS lesions)
c) SSRIs, BBs, ACEIs, diuretics, antipsychotics, anticonvulsants
ED: history and examination
a) History (suggesting psychogenic vs. organic)
b) Examination - important things to include
a) Psychogenic vs. organic causes:
- Sudden onset
- Situational erections, e.g. waking or masturbation
- Ejaculation dysfunction (e.g. rapid, inhibited)
- Problems or changes in a relationship.
- Major life events.
- Psychological problems.
b) - Genitourinary (small testes, penile abnormalities),
- CV (risk factors),
- neuro (CNS/PNS lesions),
- thyroid and other endocrine features
ED: investigations and management
a) Investigations - 3 bloods in ALL. others if indicated
b) Specialist investigations if indicated
c) Treatment of underlying cause - 4 examples
a) - HbA1c, lipid profile, early morning testosterone.
- If low testosterone, serum prolactin, FSH and LH.
- PSA in certain patients
b) - Nocturnal penile tumescence and rigidity
- Vascular studies (e.g. USS cavernous arteries)
- Neurological, endocrine or psychological work up if indicated.
c) - Low testosterone (testosterone),
- Pelvic trauma (pelvic surgery),
- CVD (secondary prevention),
- Psychological (psychosexual therapy - SPIC)
ED symptom: management
d) Symptomatic treatment - 1st line class (example)
e) Comparing the different 1st line treatments
f) Potential adverse effects/contraindications to PDE5 inhibitors
g) PDE5 inhibitors also used to treat…?
h) Adjuvant treatment
i) 2nd line medications (3 routes)
j) 3rd line treatment
d) Phosphodiesterase-5 (PDE-5) inhibitors (e.g. sildenafil)
e) Tadalafil has a longer half life than sildenafil so may lead to greater spontaneity
f) Can cause headache, flushing, dizziness and severe and fatal hypotension; DO NOT COMBINE WITH NITRATES. May also cause priapism
g) Pulmonary hypertension
h) Penile vacuum
i) PGE1 (intraurethral, intracavernosal, topical)
j) Penile prosthesis
Delayed/inhibited ejaculation
a) Must occur how often?
b) Must not be…?
a) Occurs almost or all occasions (75-100%) either generalised or situational
b) Not desired by the individual
Rapid ejaculation
a) Define
b) Occurs how long after vaginal penetration?
c) Risk factors
a) The recurrent/persistent inability to control ejaculation sufficiently for both partners to enjoy sexual interaction, causing psychological distress
b) Within 1 minute (approx) and before the individual wishes it.
c) genetics, obesity, poor health, neuro (MS, DM), emotional problems and stress, previous sexual trauma
Rapid ejaculation: management
a) General advice
b) Systemic medications
c) Topical medications
d) Possible surgery
a) Woman on top, more frequent sex/masturbation, use condom, squeeze and stop and go technique
b) SSRI, SNRI, tramadol
c) Anaesthetic creams
d) Frenulectomy if short frenulum might be the cause
Dyspareunia
a) Define
b) Must not be caused by what 2 things?
c) Superficial: causes
d) Deep: causes
a) Pain during intercourse in either women or men
b) Not caused by VAGINISMUS or LACK OF LUBRICATION
c) Vaginal atrophy, lichen sclerosis, vulvodynia, thrush, herpes, psychogenic
d) PID, endometriosis, ovarian cyst, cervical pathology, psychogenic (partner, relationship difficulty)
Dyspareunia:
e) History and examination
f) investigations
g) management
e) Full history including sexual history and examination (start with single digit, then bimanual and speculum)
f) swabs, urine dipstick, hormones, ?USS, ?laparoscopy
g) treat underlying cause, psychosexual therapy
(Systemic, Psychodynamic, Integrated, CBT), oral or vaginal oestrogens (especially in menopause)
Vaginismus
a) Define (ICD-10)
b) DSM-V (genito-pelvic pain/penetration disorder) - 3 key features (PAT)
c) May lead to failure of what 3 things to enter vagina?
d) Other common symptoms
e) Investigations
f) Management
a) involuntary contraction of the vaginal musculature, which usually results in the failure of penetration
b) DSM-V:
P - pain or difficulty during penetration attempt
A - anxiety or fear in anticipation of penetration
T - tensing or tightening of pelvic floor muscles during attempted penetration
c) Penis, finger (examination), tampon
d) FSD - lack of RIPE (responsiveness, interest, pleasure or erotic thoughts), dyspareunia, anorgasmia, psychological distress, relationship problems
e) Full sexual, Obs and gynae, psychological history. PV and bimanual examination (if possible)
f) - Psychosexual (Systemic, Psychodynamic, Integrated, CBT)
- couples counselling referral (Relate)
- Vaginal trainers
Peyronie’s disease
a) What is it?
b) Risk factors
c) Symptoms
a) Fibrous plaque formation in the tunica albuginea of the penis
b) Prostatectomy, Dupuytren’s
c) Pain, erectile dysfunction, and penile deformity (bending, twisting) that negatively affect the quality of life of affected men.
Hypospadias
a) What is it?
b) Treatment?
a) - Hypospadias is a birth defect that involves an abnormally placed urinary meatus (opening).
- Can be anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum.
- A distal hypospadias may be suspected even in an uncircumcised boy from an abnormally formed foreskin and downward tilt of the glans
b) Surgical correction +/- circumcision
