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Dip GUM > Sexual Dysfunction > Flashcards

Sexual Dysfunction Flashcards

1
Q

What is primary vulvodynia?

A

Chronic vulval pain of more than 3 months dating from 1st sexual experience or tampon use

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2
Q

What is secondary vulvodynia?

A

Chronic vulval pain of more than 3 months developing after previous pain free sexual intercourse

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3
Q

Associations with vulvodynia

A

Change in sexual partner
Thrush
STI
Depression / anxiety

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4
Q

Causes of dysparunia

A 
Vulvovaginitis (esp thichomoniasis and candida)
Vaginal cysts
Infected bartholins gland
Post menopause
Congenitally small ostium / thick hymen 
Deep retroverted uterus 
Chronic pelvic infection
Endometriosis
Adenomyosis
Pelvic tumours
Ectopic pregnancy
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5
Q

What is premenstrual syndrome

A

Physical and/or psychological symptoms
affecting some women up to 10 days prior to menstruation.
Acne, breast tenderness, bloating, fatigue, nervousness, irritability, emotional disturbance, headache, mood changes.
Usually resolves with or after menstruation

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6
Q

what conditions are often associated with vulvodynia

A

anxiety
depression
somatisation
hyperchondriasis

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7
Q

management options for vulvodynia

A 
pelvic floor excercises
external / internal soft tissue self massage with organic lubricants
trigger point pressure
biofeedback
vaginal trainers
accupuncture
lidocaine gel / capsicum cream
amitryptilline / gabapentin / pregabalin
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8
Q

what is hypoactive sexual desire disorder?

A

loss of Iibido
decline in sexual desire
causing distress and interpersonal difficulties

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9
Q

causes of hypoactive sexual desire disorder?

A 
psychosexual cause
physical causes 
- depression 
- menopause
- TCAs
- SSRIs
- chemotherapy
- radiotherapy
- oophorectomy
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10
Q

What is tokophobia

A

fear of pregnancy and childbirth

more common in primigravid women
anecdotally is increasing

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11
Q

causes of tokophobia

A

primary tokophobia = in nullips / primips

  • adolescence - avoid pregnancy at all costs
  • cultural attitudes
  • family attitudes
  • media
  • childhood or adulthood abuse

secondly tokophobia - occurs after previous birth

  • previous traumatic birth
  • previous instrumental delivery
  • spontaneous birth
  • previous termination
  • previous still birth
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12
Q

factors to explore in women with tokophobia

A 
triggering factors
causes of concern
- fear of pain
- loss of control
- fear of harm to them
- fear of harm to the baby
- lack of support
- concern birth will stretch vagina
- concern anatomy is not normal
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13
Q

What does LOFTI stand for in a psycho-sexual consultation

A 
Listening
Observing
Feelings
Thinking
Interpreting
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14
Q

examples of defence mechanisms in psychosexual patients

A 
regression 
dissociation 
introjection 
sublimation
denial
avoidance
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15
Q

what is vaginismus

A

involuntary spasm of the pubococcygeus muscle and associated muscles
causing painful and difficult vaginal penetration

can be primary or secondary

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16
Q

What may erectile dysfunction be an early marker for?

A

coronary artery disease (CAD) and generalized arteriopathy

17
Q

first-line medical treatment for erectile dysfunction

A

Phosphodiesterase inhibitors type 5

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • Avanafil (Spedra)
  • vardenafil (Levitra)
18
Q

factors potentially contributing to delayed ejaculation in men with HIV

A

medications (especially antidepressants)
penile sensation loss due to neuropathy (incl drug- induced)
endocrinopathies
psychological

19
Q

factors potentially contributing to female sexual dysfunction in women with HIV

A 
Fear of onward transmission 
difficulties negotiating condom use 
menopause
low CD4 count
low mood 
poor body image 
neuropathy (HIV or drug- induced)
endocrine disturbances
atherosclerosis
20
Q

Aetiology of Localised provoked vulvodynia (vestibulodynia)

A

Likely multifactorial

History of vulvovaginal candidiasis, usually recurrent - is commonly reported

21
Q

Symptoms of localised provoked vulvodynia

A

Vulval pain – frequently at the introitus at penetration during sex or on insertion of tampons
Usually a long history

22
Q

Signs of localised provoked vulvodynia

A

Focal tenderness

elicited by gentle application of a cotton wool tip bud at the introitus or around the clitoris

23
Q

Complications of localised provoked vulvodynia

A

Sexual dysfunction and psychological morbidity

24
Q

Diagnosis of localised provoked vulvodynia

A

Clinical diagnosis

history and examination

25
Q

Further investigation of localised provoked vulvodynia

A

Exclusion other treatable causes

Biopsy only if there is any suspicion of an underlying dermatosis

26
Q

Treatment of localised provoked vulvodynia

A 
Avoid irritating factors
Use emollient soap substitute. 
Topical local anaesthetics - e.g. 5% lidocaine ointment / 2% lidocaine gel - use with caution - may cause irritation 
Pelvic floor muscle biofeedback
Vaginal transcutaneous electrical nerve stimulation
Vaginal trainers 
CBT 
Psychosexual counselling.

Pain modifiers – amitriptyline / TCAs, gabapentin, pregabalin.
Surgery – modified vestibulectomy - considered if other measures unsuccessful. Patients who responded to topical lidocaine prior to sex have a better outcome

27
Q

Follow-up for patients with localised provoked vulvodynia

A

As clinically required

Long-term follow-up and psychological support may be needed

28
Q

Aetiology of Unprovoked vulvodynia

A

Aetiology unknown

Condition best managed as a chronic pain syndrome

29
Q

Symptoms of unprovoked vulvodynia

A 
Pain 
Longstanding 
Unexplained
May be associated with urinary symptoms
Can be associated with irritable bowel syndrome and fibromyalgia
30
Q

Signs of unprovoked vulvodynia

A

vulva appears normal

31
Q

Complications of unprovoked vulvodynia

A

Sexual dysfunction

Psychological morbidity.

32
Q

Diagnosis of unprovoked vulvodynia

A

Clinical diagnosis
Made on history and examination
Once excluded other causes

33
Q

Further investigations for suspected unprovoked vulvodynia

A

Exclude other treatable causes

Biopsy ONLY if any suspicion of alternative diagnosis

34
Q

Treatment of unprovoked vulvodynia

A

Use of emollient soap substitute
Pain modifiers – TCAs (amitriptyline) frequently 1st line; gabapentin or pregabalin
Topical local anaesthetic - e.g. 5% lidocaine ointment / 2% lidocaine gel
CBT
Psychotherapy
Acupuncture
Physiotherapy -if evidence of a weak pelvic floor
Referral to a pain clinic

35
Q

Follow up of patients with unprovoked vulvodynia

A

As clinically required

36
Q

recommended dose of amitryptiline for unprovoked vulvodynia

A

Start at 10mg ON

increase by small increments up to 100mg daily according to the patient’s response

37
Q

what is Dyspareunia

A

Pain on sexual intercourse

38
Q

what is anorgasmia

A

female failure to reach orgasm

and finds this a problem

Dip GUM (27 decks)

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