Sexual dysfunction

Question 1

What is the incidence of sexual dysfunction?

Answer 1

40-50%

Question 2

Outline the stages of the sexual response cycle

Answer 2

Excitement
Plateau
Orgasm
Resolution

Question 3

What investigations may you order in an assessment for sexual dysfunction?

Answer 3

• Urinalysis

- If menstrual changes or oestrogen deficiency: FSH, LH, oestradiol, prolactin, TFTs

Question 4

Briefly outline management / approach to a patient with sexual dysfunction

Answer 4

• Allow time
• Permission giving: to express their concerns.
• Limited information: dispel misperceptions.
• Specific suggestions: e.g. foreplay, lubrication, time together without sex, self-masturbation, oestrogen replacement, dilators, privacy
• Intensive therapy: referral to psychosexual counselling or psychology

Question 5

List five types of sexual dysfunction disorders and a cause for each

Answer 5

Hypoactive sexual desire disorder: low mood, antidepressants, menopause, stress, violence and abuse.

Sexual aversion disorder: sexual or physical abuse.

Sexual arousal disorder: pelvic floor dysfunction, incontinence, vascular disease, diabetes, menopause.

Orgasmic disorders: abuse, ineffective sexual technique, low self esteem, fear of losing control, SSRI, multiple sclerosis, diabetes

Sexual pain disorder:

• Dyspareunia: endometriosis, atrophy, vulvitis, PID, imperforate hymen, Mullerian abnormality, scarring from delivery/tears/episiotomy, lack of arousal, previous abuse, cultural.
• Vaginismus: abuse or painful experience, idiopathic

Question 6

What is the pathophysiology of vaginismus?

Answer 6

Involuntary pelvic floor muscle spasm making penetration painful or impossible.

Question 7

What management strategies can be used for vaginismus?

Answer 7

Familiarise with anatomy
Relaxation techniques.
Kegels exercises.
Graduated vaginal dilators.
Maintain control during intercourse; her on top

Question 8

What are the causes of low libido or sexual desire in males?

Answer 8

Progressive decrease in testosterone with age (increased SHBG and decreased bioavailable testosterone.
Psychological (especially young men).
Depression.

Question 9

What are the side-effects associated with testosterone therapy?

Answer 9

Prostate problems.
Polycythaemia.
OSA.

Question 10

What are the management options for erectile dysfunction?

Answer 10

Address medical conditions contributing.
Oral med: selective PDE5 inhibitor e.g. Sildenafil.
Injectable: PDE1 or alprostadil
Vacuum erection devices.
Penile implants

Question 11

What are management options for premature ejaculation?

Answer 11

Reassurance and explanation of normal intra-vaginal ejaculation latency time.
Stop-start and squeeze techniques.
SSRI for inhibiting effect.