Sexual Dysfunction, Psychosexual Health

Question 1

Sexual function depends on what 2 neurologic pathways?

Answer 1

1. connection btwn brain and genitals
2. reflex loop between genitals and spinal cord
   - both invole CNS, PNS, and ANS

Question 2

Abnormal sexuality:

-definition

Answer 2

Sexual behavior that is destructive to a person, cannot be directed toward a partner, is inappropriately associated with guilt and anxiety, or is compulsive

Question 3

Sexual response linear model

-what are the phases? (4)

Answer 3

1. sexual arousal
2. plateau
3. orgasm
4. resolution

Question 4

Examples of Biological causes of sexual dysfunction:

what can these cause?

1. diabetes
2. pelvic adhesion
3. SSRIs
4. alcohol

Answer 4

1. Erectile dysfunction
2. dyspareunia (painful sex)
3. delayed orgasm
4. ED

Question 5

Erectile dysfunction

-What do you ask the pt to help determine if there is a psychological vs biological cause

Answer 5

• Ask if pt experiences erections outside of desired time he wants an erection:
• morning erections
• masturbation
• erections during REM sleep

Question 6

Erectile disorder

-definition is 1+ symptoms occuring >75% of the time. What are these symptoms? (3)

Answer 6

1. difficulty obtaining erection during sex
2. difficulty maintaining erection during sex
3. marked decrease is erectile rigidity

Question 7

What is:
1. Female Sexual Arousal Disorder

2. Female Orgasmic Disorder
   - prevalence for both?

Answer 7

1. Reduced interest in sexual activity (up to 33% of females)
2. Marked delay/absence and/or reduced intensity of orgasmic sensations

(30% overall prevalence)

Question 8

Premature ejaculation

-defined by what timeframe

Answer 8

-ejaculation within 1 minute of vaginal penetration, and before guy wishes it

Question 9

Vaginismus

Answer 9

• recurrent involuntary contraction of perineal muscles surrounding outer 1/3 of vagina. Prevents penile insertion
• anticipation of vaginal insertion can cause vaginismus spasm

Question 10

Dyspareunia

Answer 10

• genital pain associated with sexual intercourse
• more common in females

Question 11

SSRIs

-what sexual disorder can they be used to treat?

Answer 11

-Treat premature ejaculation. This is SSRI’s side effect of delayed orgasm

Question 12

Opioid antagonists, vasodilators

-used to treat what sexual disorders?

Answer 12

Can be used to treat erectile disorders

Question 13

How does sildenafil work to treat ED?

Answer 13

PDE5 inhibitors:

-increase concentration of cGMP in vascular smooth muscle cells. This relaxes smooth m and allows blood to fill

Question 14

Gender Dysphoria

• what is it
• how to “treat?” (3)

Answer 14

aka Gender Identity disorder

-Persistent identificaiton with other gender, along with persistent discomfort.

“treatment” can allow pt to better live their desired gender

1. Therapy
2. Hormone therapy
3. sexual reassignment surgery

Question 15

Postpartum blues

• when do the ‘blues’ peak?
• self limiting within how long?
• how many women affected?

Answer 15

• Peaks 3-5 days post delivery
• typically resolves within 2 weeks
• 70-85% of women, so normal

Question 16

Postpartum depression

• onset timeframe
• incidence

Answer 16

Onset typically within 2-12 weeks (postpartum blues peaks 3-5 days and resolves within 2 weeks)

10-12% incidence

Question 17

Postpartum blues vs Postpartum depression

-how to differentiate

Answer 17

Blues:

• self limiting within 2 weeks.
• mild symptoms

Depression:

• last for more than 2 weeks
• Onset is usually later (2 weeks or later)
• severely impacts mother’s functioning

Question 18

Postpartum depression:

-what are 2 important risk factors to know

Answer 18

1. history of depression
2. history of postpartum depression (risk increases to 25-50% incidence for subsequent episode)