Sexual Health🍆 Flashcards
1
Q
What kind of bacteria is chlamydia trachomatis?
A
Gram negative bacteria
2
Q
What are the risk factors for chlamydia infection? (3)
A
Under 25 Multiple sexual partners New sexual partnerA partner with other partners History of STIsUnprotected sex
3
Q
What are the two types of swabs used in sexual health testing?
A
Charcoal swab - from endocervical or high vaginal areaNucleic acid amplification test
4
Q
What is the purpose of a charcoal swab?
A
Allows for microscopy, culture and sensitivity
5
Q
What is NAAT testing?
A
Checks for the DNA or RNA of the organism - Only used for chlamydia and gonorrhoea
6
Q
What specimens can NAAT testing be performed on? (3)
A
Low vaginal swab First catch urine - men and women Endocervical swab
7
Q
What is the presentation of chlamydia? (5)
A
Abnormal vaginal discharge Pelvic pain Dyspareunia Dysuria Post coital bleeding Intermenstrual bleedingPenile discharge
8
Q
What is the first line investigation for chlamydia?
A
NAAT swab
9
Q
What are the differentials of chlamydia? (3)
A
Gonorrhoea Bacterial vaginosis Thrush Trichomonas Mycoplasma infectionPID
10
Q
What is the first line management of chlamydia?
A
100mg doxycycline BD for 7 days
11
Q
What is the first line management of chlamydia in pregnant women?
A
Oral Azithromycin 1g single dose
12
Q
What are the complications of chlamydia infection? (5)
A
PID
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Reactive arthritis
Lymphogranuloma venereum
13
Q
What are the pregnancy related complications of chlamydia? (3)
A
Premature delivery
Premature ROM
Low birthweight
Postpartum endometritis
Neonatal conjunctivitis
Neonatal pneumonia Chorioamnionitis
14
Q
What is lymphogranuloma venereum?
A
A lesion affecting the lymphoid tissue around the site of infection with chlamydia Most commonly occurs in MSM
15
Q
What bacteria is gonorrhoea caused by?
A
Neisseria gonorrhoeae
16
Q
What type of bacteria is neisseria gonorrhoeae?
A
Gram negative diplococci
17
Q
What antibiotics are many strains of gonorrhoea now resistant to?
A
Azithromycin and ciprofloxacin
18
Q
What is the presentation of gonorrheoa infection? (3)
A
Female:- Odourless purulent discharge - green or yellow - Dysuria - Pelvic pain Male:- Dysuria - Odourless purulent discharge - green or yellow - Testicular painWomen more likely to be asymptomatic
19
Q
What are the risk factors for gonorrhoea infection? (3)
A
Age 15-24 Black ancestryCurrent/prior history of STIMultiple recent sexual partnersInconsistent condom use MSM Partner with risk factors History of sexual or physical abuse
20
Q
What are the differentials of gonorrhoea? (3)
A
ChlamydiaTrichomonas Mycoplasma PIDCandidiasisUTI
21
Q
What is the first line investigation for diagnosis of gonorrhoea?
A
NAAT testing (detect RNA or DNA)
Standard charcoal endocervical swab for microscopy, culture and sensitivity before initiating antibiotics
22
Q
What type of swabs can be used for NAAT diagnosis of gonorrhoea?
A
Endocervical Urethral Vulvovaginal Rectal (MSM) Pharyngeal (MSM)
23
Q
How else can gonorrhoea be diagnosed?
A
First catch urine
24
Q
What is the first line management of gonorrhoea?
A
1g IM ceftriaxone
25
What follow up does the patient require after gonorrhoea infection?
The patient needs follow up 'test of cure'- After 72hrs for culture - After 7 days for DNA NAAT- After 14 days for RNA NAAT
26
What are the complications of gonorrhoea? (3)
PID Chronic pelvic pain InfertilityConjunctivitis Epididymo-orchitis Disseminated gonorrheal infection Urethral stricture
27
What does disseminated gonorrheal infection cause? (3)
Non-specific skin lesions
Polyarthralgia
Migratory polyarthritis
Systemic systems - fever and fatigue
28
What is the key complication of gonorrhoea in a neonate?
Neonatal conjunctivitis - opthalmia neonatorum
29
What is bacterial vaginosis?
BV is an overgrowth of anaerobic bacteria in the vagina, and a loss of lactobacilli
30
What bacteria are associated with BV? (3) which is the most common?
Gardnerella vaginalis (most common) Mycoplasma hominis Prevotella sp
31
What are the risk factors for BV? (3)
Multiple sexual partnersExcessive vaginal cleaning Recent antibioticsSmoking Copper coil
32
What is the presentation of BV? (2)
Grey or white watery discharge Fishy smelling odour 50% of women are asymptomatic
33
What is Amsel's criteria for BV?
3 out of 4 symptoms must be present:- Positive whiff test - fishy smell when potassium hydroxide is added - Grey or white discharge - Clue cells on microscopy - Vaginal pH > 4.5
34
What is the normal vaginal pH?
3.5-4.5
35
What are the first line investigations for BV? (2)
Vaginal pH using swab and pH paperCharcoal vaginal swab for microscopy
36
What are clue cells?
Epithelial cells from the cervix that have bacteria stuck inside of them
37
What is the first line treatment of BV?
Asymptomatic BV does not require treatment If symptomatic:- Oral metronidazole for 5-7 days
38
What are the complications of BV?
Increased risk of catching STIsComplications in pregnant women:- Miscarriage - Preterm delivery - Premature ROM - Low birthweight - Chorioamnionitis
39
What is candidiasis?
Vaginal infection with yeast of the candida family
40
What is the most common organism that causes thrush?
Candida albicans
41
What are the risk factors for thrush? (3)
Increased oestrogen - COCPPoorly controlled diabetesImmunosuppression Broad-spectrum antibioticsHIV
42
What is the presentation of thrush? (3)
Non-offensive 'cottage cheese' discharge Vuval and vaginal itching Dysuria Superficial dyspareuniaVulval erythema
43
What is the first line investigation of thrush?
Usually clinically diagnosed Vaginal pH (differentiate from BV) high vaginal swab - microscopy (diagnostic)
44
What is the first line management of thrush?
Single oral 150mg fluconazole Single 500mg clotrimazole vaginal pessary External clotrimazole cream for vulval symptoms
45
What is classed as recurrent thrush?
More than 3 episodes in one year
46
What is the treatment of recurrent thrush?
Induction-maintenance regime - Oral fluconazole every 3 days for 3 doses- Oral fluconazole weekly for 6 months
47
What is the first line of candidiasis in pregnanct women?
Clotrimazole pessary - oral fluconazole is contraindicated in pregnancy
48
What is mycoplasma genitalium?
A bacteria that causes non-gonococcal urethritis
49
What is the presentation of mycoplasma genitalium? (2)
Urethritis- urethral discharge and dysuria Epididymitis Cervicitis Endometritis PID Reactive arthritis Most cases are asymptomatic
50
What is the first line investigation for mycoplasma genitalium? (3)
NAAT testing First catch urine in men Vaginal swab in women (can be self taken)
51
What is the treatment of mycoplasma genitalium? (2)
Doxycycline 100mg BD for 7 days then Azithromycin 1g stat and 500mg OD for 2 days
52
What is the treatment of mycoplasma genitalium in pregnancy?
Azithromycin alone - doxycycline is contraindicated in pregnancy
53
What is used as an alternative medication if mycoplasma is resistant to macrolides?
Moxifloxacin
54
What is trichomoniasis? What type of organism is it?
Trichomoniasis is an STI caused by the protozoa trichomonas vaginalis
55
What are the complications of trichomonas infection? (3)
Contracting HIV by damage to the vaginal mucosa
BV
Cervical cancer
PID
Pregnancy related complications eg preterm delivery
56
What is the presentation of trichomoniasis? (3)
- vaginal discharge: offensive, yellow/green, frothy
- vulvovaginitis
- strawberry cervix
- pH > 4.5
- in men is usually asymptomatic but may cause urethritis
57
How is trichomoniasis diagnosed?
Charcoal swab with microscopy Women - posterior fornix swab, or low vaginal swab Men - First catch urine or urethral swab
58
What is the management of trichomoniasis?
Oral metronidazole for 5-7 daysOR 2g PO metronidazole stat
59
What strain of herpes virus typically causes genital herpes?
HSV-2
60
How can HSV-1 be contracted as genital herpes?
Through oro-genital sex
61
Where does the herpes virus become latent in after infection?
Sensory nerve ganglia- Trigeminal nerve ganglia in cold sores - Sacral nerve ganglia in genital herpes
62
What strain of herpes virus usually causes cold sores?
HSV-1
63
What is the presentation of genital herpes? (3)
-painful genital ulceration
may be associated with dysuria and pruritus
- the primary infection is often more severe than recurrent episodes
systemic features such as headache, fever and malaise are more common in primary episodes
- tender inguinal lymphadenopathy
- urinary retention may occur
64
How long can symptoms last during the primary infection of genital herpes?
Up to 3 weeks
65
How is diagnosis of genital herpes made?
NAAT testing
66
What measures can be used to manage the symptoms of genital herpes? (3)
Paracetamol Topical lidocaine gel Cleaning with warm salt waterAdditional oral fluids Wear loose clothing Avoid intercourse
67
What is the main medical treatment of genital herpes?
Oral acyclovir
68
What is the risk of genital herpes during pregnancy?
Risk of neonatal herpes simplex infection, which has high morbidity and mortality
69
How are herpes antibodies passed on from mother to baby?
The antibodies that the woman develops to the virus can pass across the placenta
70
What is the treatment of primary genital herpes before 28 weeks?
Initial infection treated with acyclovir
Prophylactic acyclovir started at 36 weeks gestation
Women that are asymptomatic can have a normal vaginal delivery
71
What is the treatment of primary genital herpes after 28 weeks
Initial infection treated with acyclovir, and prophylactic acyclovir is started immediately C-section recommended
72
What bacteria is syphilis caused by?
Syphilis is caused by Treponema pallidum, a spiral shaped bacteria (spirochete)
73
How can syphilis be contracted? (3)
Oral, vaginal or anal sexVertical transmission from mother to baby IV drug use Blood transfusion
74
What are the symptoms of primary syphilis?
Chancre on the genitals (lesion may not be seen in women)Non-tender lymphadenopathy
75
What are the symptoms of secondary syphilis? (3)
Systemic symptoms - fever, lymphadenopathy Rash on trunk, palms and soles Buccal 'snail track' ulcers
76
How long after the primary stage does secondary syphilis develop?
6-10 weeks
77
What is the latent stage of syphilis?
Occurs after the secondary stage - the patient becomes asymptomatic despite still being infected with syphilis
78
When is the early latent stage of syphilis?
Within 2 years of initial infection
79
How long do secondary syphilis symptoms last for?
3-12 weeks
80
When is the late latent stage of syphilis?
From two years after the initial infection onwards
81
What are the features of tertiary syphilis? (3)
Gummas (granuloma) Ascending aortic aneurysms General paralysis of the insane Tabes dorsalis Argyll-Robertson pupil ocular syphilis
82
What is tabes dorsalis?
demyelination affecting the spinal cord posterior columns
83
What is Argyll-Robertson pupil?
Bilaterally small pupils that do not constrict in response to bright light but do constrict when focussed on a close object (accommodation)
Prostitutes pupils- accommodates but doesn’t react
84
What are the features of congenital syphilis? (3)
Blunted upper incisor teeth Rhagades (linear scars in the skin around the mouth and nose)KeratitisDeafnessSaber shinsSaddle nose
85
What is the first line investigation for syphilis?
Screening test - antibody test for antibodies to T. pallidum
86
What further testing can be done in patients suspected of having syphilis?
Swabs from infected sites can be processed through: - Dark field microscopy - PCR
87
What is the first line management of syphilis?
IM benzanthine benzylpenicillin
88
What is an alternative antibiotic in the treatment of syphilis?
Doxycycline
89
What is the Jarisch-Herxheimer reaction?
A reaction seen hours after the treatment of spirochete infections due to the release of endotoxins following bacterial death:- Fever, rash and tachycardia
90
What are the features of congenital syphilis? (3)
- blunted upper incisor teeth (Hutchinson's teeth), 'mulberry' molars
- rhagades (linear scars at the angle of the mouth)
- keratitis
- saber shins
- saddle nose
- deafness
91
What type of virus is HIV?
HIV is an RNA retrovirus
92
What is the most common type of HIV?
HIV-1
93
What type of HIV is mainly found in Western Africa?
HIV-2
94
What is the pathophysiology of HIV?
The virus enters and destroys the CD4 T helper cells of the immune system
95
How can HIV be transmitted? (3)
Unprotected anal, vaginal or oral sex Vertical transmission Exposure to infected bodily fluids
96
How does HIV replicate inside the body?
Once in the T helper cells, it uses the enzyme reverse transcriptase to convert viral RNA into a DNA copy
97
What is HIV seroconversion?
When the body starts to produce antibodies to HIV- After seroconversion, HIV can be tested for
98
What are the symptoms of HIV seroconversion? (5)
Flu-like illness symptoms - Sore throat- Lymphadenopathy - Diarrhoea - Malaise, myalgia - Maculopapular rash - Mouth ulcers
99
How long after infection does seroconversion occur?
3-12 weeks
100
What are the risk factors for HIV infection? (3)
IV drug use Homo and heterosexual unprotected intercourse Percutaneous needlestick injuryHaving another STI
101
What methods are used to diagnose HIV? (2)
HIV antibodies p24 antigen
102
How are HIV antibodies used to diagnose HIV?
ELISA test and a confirmatory Western Blot assay are used to detect antibodies to HIV
103
After how long can HIV antibodies be detected in the blood?
Most people have antibodies by 4-6 weeks, but 99% of people have antibodies by 3 months
104
How are p24 antigens used to diagnose HIV?
A viral core protein can be detected as RNA viral levels increase in the blood
105
When can p24 antigens be detected in the blood?
Between 1 weeks and 3-4 weeks after infection
106
How are most people diagnosed with HIV?
A test combining p24 antigen testing and HIV antibodies
107
When should an asymptomatic patient be offered testing after a possible HIV exposure?
4 weeks after the exposure - Repeated at 12 weeks if first test is negative
108
What are the differentials of HIV infection? (3)
Infectious mononucleosis CMV InfluenzaViral hepatitis Secondary syphilis
109
What is the normal CD4 count range?
500-1200 cells/mm3
110
Under what CD4 count puts a patient at risk of opportunistic infections?
200
111
What is the main treatment of HIV?
Anti-retroviral treatment
112
Who is antiretroviral treatment offered to?
All patients regardless of CD4 count - ART should be started as soon as a HIV diagnosis is made
113
What are the classes of ART? (5)
Protease inhibitors Integrase inhibitors Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitorsEntry inhibitors
114
What is the usual starting regime for HIV treatment?
Two NRTIs plus an additional drug
115
What additional management is required in HIV? (3)
Prophylactic co-trimoxazole for patients with CD4 count under 200Yearly cervical smears Up to date vaccinations
116
When can a woman with HIV have a normal vaginal birth?
If viral load is under 50
117
What drug can be given to a woman in labour to prevent the vertical transmission of HIV?
IV zidovudine
118
What prophylaxis may be given to a baby with a HIV positive mother?
Zidovudine for 4 weeks
119
What is the safest advice to breastfeeding mothers that are HIV positive?
To avoid breastfeeding - HIV can be transmitted through breast milk
120
What is PEP? What is the time frame for administration after HIV exposure?
Post exposure prophylaxis - Given within 72 hours to patients who have been exposed to HIV
121
What is the current combination of drugs used in PEP?
emtricitabine/tenofovir (Truvada) and raltegravir for 28 days
122
What is PrEP? What is the time frame for taking PrEP prior to exposure?
Pre-exposure prophylaxis for HIV
(one tablet a day for 7 days prior, or if within 7 days, 2 tablets at least 2 hours before then carry on with 1 a day)
123
What is the current combination of drugs used in PrEP?
emtricitabine/tenofovir (Truvada)
124
What are the most common AIDS defining illnesses? (4)
Kaposi's sarcoma Pneumocystis jirovecii pneumonia Cytomegalovirus infection Candidiasis Lymphomas TB
125
When should children be tested for HIV? (3)
Babies to HIV positive parents When immunodeficiency is suspected Young people who are sexually active and there are concerns Needle stick injuries Sexual abuse IV drug use
126
What eye conditions may be seen in someone with HIV? (3)
CMV retinitis Kaposi's sarcoma HSV infection VSV infection Tuberculosis
127
What is the presentation of CMV retinitis?
Reduced visual acuity
Pizza pie appearance on fundoscopy - areas of thick white infiltrate accompanied by retinal haemorrhages
128
What is the treatment of CMV retinitis?
Intra-ocular ganciclovir Oral valganciclovir
129
What is Kaposi's sarcoma?
A cancer caused by HSV-8 commonly seen in patients with HIV
130
Where does Kaposi's sarcoma develop from?
Endothelial cells - It is seen in the skin
131
What is the appearance of Kaposi's sarcoma?
Purple papules or plaques on the skin
132
What is the treatment of Kaposi's sarcoma?
Radiotherapy Resection
133
What types of cancers is HIV associated with? (3)
AnalLiverLung Hodgkin's lymphoma Burkitt's lymphoma Kaposi's sarcoma
134
What is the treatment of pneumocystis jiroveci pneumonia?
Co-trimoxazole
135
What are the features of pneumocystis jiroveci pneumonia? (3)
Bilateral bihilar interstitial infiltrates Desaturating on exertion Non-productive cough Poorly controlled HIV
136
How should anti-retrovirals be taken?
They should be taken at the same time every day
137
What are genital warts caused by?
HPV infection
138
Which types of HPV most commonly cause genital warts?
HPV 6 and 11
139
What are the features of genital warts? (3)
Small fleshy protuberences that are slightly pigmented Lesions may bleed or itch
140
What are the risk factors for genital warts? (3)
Not vaccinated against HPV Earlier sexual intercourse Increasing number of lifetime sexual partners Immunocompromised Unprotected sex
141
How are genital warts transmitted?
Mostly through skin to skin contact during sexual intercourse
142
How are genital warts diagnosed?
Mostly clinical diagnosis - can be confirmed with a biopsy
143
What is the first line treatment of genital warts? (2)
Topical podophyllum (non-keratinised, multiple) Cryotherapy (keratinised, solitary)
144
What is the second line treatment of genital warts?
Imiquimod cream
145
What is balanitis?
Inflammation of the glans penis and prepuce (foreskin)
146
What are the causes of balanitis? (3)
Atopic eczema
Allergic contact eczema
Psoriasis
Lichen sclerosis
Candidosis
Gonorrhoea
Carcinoma in situ
Bacterial causes
147
What bacteria most commonly causes balanitis?
Staphylococcus species
148
What are the risk factors for balanitis? (3)
Uncircumsised
Congenital or acquired dysfuntional foreskin
Poor hygeine
Overwashing
HPV infection
Multiple partners
High risk sexual behaviours
149
What are the features of balanitis? (3)
Penile soreness
Dysuria
Itchiness, bleeding, and erythema of the glans penis.
150
How is balanitis diagnosed?
Mostly clinically diagnosed- Can confirm with swab microscopy and culture for candida albicans or bacteria
151
What is the general treatment of balanitis? (3)
Gentle saline washesWashing properly under the foreskin 1% hydrocortisone cream
152
What is the treatment of balanitis caused by candida?
Topical clotrimazole for two weeks
153
What is the treatment of balanitis caused by staphylococcus?
Oral flucloxacillin or clarithromycin
154
What is the treatment of balanitis caused by lichen sclerosis?
High potency topical steroids
155
What is chancroid?
An STI caused by Haemophilus ducreyi
156
Where is chancroid common?
Most common in tropical and subtropical resource poor countries
157
What type of bacteria is Haemophilus ducreyi?
Gram negative coccobacillus
158
What are the risk factors for chancroid? (3)
Unprotected sex High number of sexual partnersSex work Cocaine use Uncircumsised
159
How long after exposure to chancroid do symptoms take to develop?
4-10 days
160
What is the presentation of chancroid? (2)
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement
161
What are the differentials of chancroid? (3)
Syphilis Herpes simplex Lymphogranuloma venereum
162
What investigations can be used to confirm a diagnosis of chancroid? (2)
Culture PCRLymph node aspirate culture
163
What is the management of chancroid?
Antibiotic treatment - options include:- Azithromycin - Ciprofloxacin - Ceftriaxone
164
What are the 4 classifications of Sexual Disorders?
Desire + drive -> hypoactive sexual desire disorder
Arousal -> erectile dysfunction
Orgasm -> ejaculation disorder, female orgasmic disorder
Resolution -> dyspareunia etc
165
What are the 2 criteria for something to be considered as a ‘sexual disorder’?
Persistent
- Cause marked distress
166
List some causes of Sexual Disorders.
Chronic medical conditions (CVD, T2DM, Obesity)
Hormonal
Iatrogenic
Psychiatric
167
What investigations might you consider if a person presented with a sexual disorder? (3)
Full Sexual hx
Examination
Blood tests
168
What blood tests might you consider if a person presented with a sexual disorder? (5)
Fasting glucose/lipid ratio
Testosterone
SHBG
Prolactin
TSH
Oestrogen
FBC
GnRH
169
Give some examples of psychological treatments for Sexual Disorders (3)
Integrative: psychosexual options and physical treatments
CBT: self growth programme
Psychodynamic: past events, attachments, partner choice
Systemic: interactions and roles in a relationship
170
Describe ‘Hypoactive Sexual Desire Disorder’.
Lack or loss of sexual desire causing distress
- It doesn’t preclude sexual enjoyment or arousal but makes the initiation of sex less likely
171
List some causes of hypoactive sexual desire disorder. (5)
Chronic disease: DM, CVD, Anaemia
Hormonal -> hyperprolactinaemia!!!!!, hypothyroid
Iatrogenic - SSRI, OCP, HRT
Psychiatric - Depression, Anxiety, Previous trauma
172
What is the treatment for hypoactive sexual desire disorder? (2)
Psychosexual: CBT, Psychodynamic therapy etc
- Medication: Testosterone replacement, Flibanserin (for pre-menopausal women)
173
Define ‘Erectile Dysfunction’.
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
174
List some causes of Erectile Dysfunction (5)
Chronic disease: CVD, DM,
Hormonal: Androgen deficiency, prolactin
Iatrogenic: Prostate surgery, SSRIs, HTN
Psychiatric: relationship problems, age, depression
175
What is 1st line treatment for Erectile dysfunction? Side effects? Contraindications?
Phosphodiesterase inhibitors (Sildenafil)
SE: Headaches + flushing
CI: Hypotension
176
What is 2nd line treatment for Erectile dysfunction?
Alprostadil (injectable or intraurethral via MUSE)
177
List 4 non-medical treatments for Erectile Dysfunction.
Vacuum Device
Penile / Scrotal device
Kegel exercises
Psychological
178
Define ‘Female Sexual Arousal Disorder’.
Failure of genital response (principal problem is vaginal dryness)
Reduced interest in sexual activity, reduced physical response to sex stimuli and reduced sexual pleasure
179
List the causes of Female Sexual Arousal Disorder (3)
Chronic disease: DM, CVD,
Hormonal: oestrogen deficiency
Iatrogenic: SSRIs
Lactation
Psychological
180
What is the treatment for Female Sexual Arousal Disorder?
Behavioural: senate focus
- Psychosexual couples therapy
181
Define rapid ejaculation.
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction.
Ejaculation occurring within 1 minute
182
Causes of rapid ejaculation? (3)
Genetic susceptibility
Hyperthyroidism
Penile hypersensitivity
Psychological (performance anxiety, inexperience)
183
Treatment for rapid ejaculation? (3)
1st line: SSRIs: Dapoxetine (increases risk of suicide)
STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, kegel exercises)
184
Define ‘Female Orgasmic Disorder’.
Orgasm either does not occur or is markedly delayed.
185
List some causes of Female Orgasmic Disorder (3)
Chronic disease: DM, CVD, Obesity
Hormonal: hyperprolactinaemia, hypothyroid
Pelvic floor weakness / damage
Ageing
SSRIs
Psychological
186
What is the treatment for Female Orgasmic Disorder? (2)
Topical oestrogen
- Behavioural interventions: guided masturbation, vibrators
187
Define ‘vaginismus’.
Spasm of the pelvic floor muscles that surround the vaginal opening.
Makes penile entry painful or impossible.
188
Causes of vaginismus? (3)
Thrush, FGM, congenital abnormality
- Psychological: previous trauma / abuse; fear / dislike of partner or pregnancy
189
Treatment for vaginismus? (2)
Psychosexual
- Behavioural: self exploration, vaginal dilators, graded penetration therapy
190
Define ‘dyspareunia’.
Pain during intercourse
Often due to local pathology
This category is used ONLY if there is no primary non-organic sexual dysfunction
191
List causes for Female dyspareunia (3)
Superficial: STIs, episiotomies, vaginal atrophy
Deep: PID, endometriosis
192
List causes for male dyspareunia (3)
STIs, Urethral strictures, Varicoceles
Psychological
Relationship causes (poor technique of partner)
193
What are the treatments for dyspareunia? (3)
Lubricants
Couples therapy
Behavioural therapy
?Refer to gynae
