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Phase 3a🩺 > Sexual Health🍆 > Flashcards

Sexual Health🍆 Flashcards

1
Q

What kind of bacteria is chlamydia trachomatis?

A

Gram negative bacteria

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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

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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

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4
Q

What is the purpose of a charcoal swab?

A

Allows for microscopy, culture and sensitivity

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5
Q

What is NAAT testing?

A

Checks for the DNA or RNA of the organism - Only used for chlamydia and gonorrhoea

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6
Q

What specimens can NAAT testing be performed on?

A

Low vaginal swab First catch urine - men and women Endocervical swab

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7
Q

What is the presentation of chlamydia? (5)

A

Abnormal vaginal discharge Pelvic pain Dyspareunia Dysuria Post coital bleeding Intermenstrual bleedingPenile discharge

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8
Q

What is the first line investigation for chlamydia?

A

NAAT swab

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9
Q

What are the differentials of chlamydia? (3)

A

Gonorrhoea Bacterial vaginosis Thrush Trichomonas Mycoplasma infectionPID

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10
Q

What is the first line management of chlamydia?

A

100mg doxycycline BD for 7 days

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11
Q

What is the first line management of chlamydia in pregnant women?

A

Oral Azithromycin 1g single dose

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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

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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

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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

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15
Q

What bacteria is gonorrhoea caused by?

A

Neisseria gonorrhoeae

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16
Q

What type of bacteria is neisseria gonorrhoeae?

A

Gram negative diplococci

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17
Q

What antibiotics are many strains of gonorrhoea now resistant to?

A

Azithromycin and ciprofloxacin

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18
Q

What is the presentation of gonorrheoa infection?

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

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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

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20
Q

What are the differentials of gonorrhoea? (3)

A

ChlamydiaTrichomonas Mycoplasma PIDCandidiasisUTI

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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

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22
Q

What type of swabs can be used for NAAT diagnosis of gonorrhoea?

A

Endocervical Urethral Vulvovaginal Rectal (MSM) Pharyngeal (MSM)

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23
Q

How else can gonorrhoea be diagnosed?

A

First catch urine

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24
Q

What is the first line management of gonorrhoea?

A

1g IM ceftriaxone

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25
Q

What follow up does the patient require after gonorrhoea infection?

A

The patient needs follow up ‘test of cure’- After 72hrs for culture - After 7 days for DNA NAAT- After 14 days for RNA NAAT

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26
Q

What are the complications of gonorrhoea? (3)

A

PID Chronic pelvic pain InfertilityConjunctivitis Epididymo-orchitis Disseminated gonorrheal infection Urethral stricture

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27
Q

What does disseminated gonorrheal infection cause? (3)

A

Non-specific skin lesions
Polyarthralgia
Migratory polyarthritis
Systemic systems - fever and fatigue

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28
Q

What is the key complication of gonorrhoea in a neonate?

A

Neonatal conjunctivitis - opthalmia neonatorum

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29
Q

What is bacterial vaginosis?

A

BV is an overgrowth of anaerobic bacteria in the vagina, and a loss of lactobacilli

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30
Q

What bacteria are associated with BV?

A

Gardnerella vaginalis (most common) Mycoplasma hominis Prevotella sp

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31
Q

What are the risk factors for BV? (3)

A

Multiple sexual partnersExcessive vaginal cleaning Recent antibioticsSmoking Copper coil

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32
Q

What is the presentation of BV?

A

Grey or white watery discharge Fishy smelling odour 50% of women are asymptomatic

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33
Q

What is Amsel’s criteria for BV?

A

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

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34
Q

What is the normal vaginal pH?

A

3.5-4.5

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35
Q

What are the first line investigations for BV?

A

Vaginal pH using swab and pH paperCharcoal vaginal swab for microscopy

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36
Q

What are clue cells?

A

Epithelial cells from the cervix that have bacteria stuck inside of them

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37
Q

What is the first line treatment of BV?

A

Asymptomatic BV does not require treatment If symptomatic:- Oral metronidazole for 5-7 days

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38
Q

What are the complications of BV?

A

Increased risk of catching STIsComplications in pregnant women:- Miscarriage - Preterm delivery - Premature ROM - Low birthweight - Chorioamnionitis

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39
Q

What is candidiasis?

A

Vaginal infection with yeast of the candida family

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40
Q

What is the most common organism that causes thrush?

A

Candida albicans

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41
Q

What are the risk factors for thrush? (3)

A

Increased oestrogen - COCPPoorly controlled diabetesImmunosuppression Broad-spectrum antibioticsHIV

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42
Q

What is the presentation of thrush? (3)

A

Non-offensive ‘cottage cheese’ discharge Vuval and vaginal itching Dysuria Superficial dyspareuniaVulval erythema

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43
Q

What is the first line investigation of thrush?

A

Usually clinically diagnosed Vaginal pH (differentiate from BV) Charcoal swab - microscopy (diagnostic)

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44
Q

What is the first line management of thrush?

A

Single oral 150mg fluconazole Single 500mg clotrimazole vaginal pessary External clotrimazole cream for vulval symptoms

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45
Q

What is classed as recurrent thrush?

A

More than 4 episodes in one year

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46
Q

What is the treatment of recurrent thrush?

A

Induction-maintenance regime - Oral fluconazole every 3 days for 3 doses- Oral fluconazole weekly for 6 months

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47
Q

What is the first line of candidiasis in pregnanct women?

A

Clotrimazole pessary - oral fluconazole is contraindicated in pregnancy

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48
Q

What is mycoplasma genitalium?

A

A bacteria that causes non-gonococcal urethritis

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49
Q

What is the presentation of mycoplasma genitalium? (3)

A

Urethritis Epididymitis Cervicitis Endometritis PID Reactive arthritis Most cases are asymptomatic

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50
Q

What is the first line investigation for mycoplasma genitalium?

A

NAAT testing First catch urine in men Vaginal swab in women (can be self taken)

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51
Q

What is the treatment of mycoplasma genitalium?

A

Doxycycline 100mg BD for 7 days then Azithromycin 1g stat and 500mg OD for 2 days

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52
Q

What is the treatment of mycoplasma genitalium in pregnancy?

A

Azithromycin alone - doxycycline is contraindicated in pregnancy

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53
Q

What is used as an alternative medication if mycoplasma is resistant to macrolides?

A

Moxifloxacin

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54
Q

What is trichomoniasis?

A

Trichomoniasis is an STI caused by the protozoa trichomonas vaginalis

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55
Q

What are the complications of trichomonas infection? (3)

A

Contracting HIV by damage to the vaginal mucosa
BV
Cervical cancer
PID
Pregnancy related complications eg preterm delivery

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56
Q

What is the presentation of trichomoniasis? (3)

A

Vaginal discharge - frothy and yellow/green Itching Dysuria Dyspareunia Balanitis - inflammation to the glans penis Strawberry cervixRaised vaginal pH

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57
Q

How is trichomoniasis diagnosed?

A

Charcoal swab with microscopy Women - posterior fornix swab, or low vaginal swab Men - First catch urine or urethral swab

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58
Q

What is the management of trichomoniasis?

A

Oral metronidazole for 5-7 daysOR 2g PO metronidazole stat

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59
Q

What strain of herpes virus typically causes genital herpes?

A

HSV-2

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60
Q

How can HSV-1 be contracted as genital herpes?

A

Through oro-genital sex

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61
Q

Where does the herpes virus become latent in after infection?

A

Sensory nerve ganglia- Trigeminal nerve ganglia in cold sores - Sacral nerve ganglia in genital herpes

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62
Q

What strain of herpes virus usually causes cold sores?

A

HSV-1

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63
Q

What is the presentation of genital herpes? (3)

A

Ulcers or blistering lesions affecting the genital areaNeuropathic pain - burning, shooting Flu-like symptoms Dysuria Inguinal lymphadenopathy

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64
Q

How long can symptoms last during the primary infection of genital herpes?

A

Up to 3 weeks

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65
Q

How is diagnosis of genital herpes made?

A

Clinical diagnosis - Ask about contacts - Can be confirmed with a viral PCR swab or NAAT testing

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66
Q

What measures can be used to manage the symptoms of genital herpes? (3)

A

Paracetamol Topical lidocaine gel Cleaning with warm salt waterAdditional oral fluids Wear loose clothing Avoid intercourse

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67
Q

What is the main medical treatment of genital herpes?

A

Oral acyclovir

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68
Q

What is the risk of genital herpes during pregnancy?

A

Risk of neonatal herpes simplex infection, which has high morbidity and mortality

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69
Q

How are herpes antibodies passed on from mother to baby?

A

The antibodies that the woman develops to the virus can pass across the placenta

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70
Q

What is the treatment of primary genital herpes before 28 weeks?

A

Initial infection treated with acyclovir
Prophylactic acyclovir started at 36 weeks gestation
Women that are asymptomatic can have a normal vaginal delivery

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71
Q

What is the treatment of primary genital herpes after 28 weeks

A

Initial infection treated with acyclovir, and prophylactic acyclovir is started immediately C-section recommended

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72
Q

What bacteria is syphilis caused by?

A

Syphilis is caused by Treponema pallidum, a spiral shaped bacteria (spirochete)

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73
Q

How can syphilis be contracted? (3)

A

Oral, vaginal or anal sexVertical transmission from mother to baby IV drug use Blood transfusion

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74
Q

What are the symptoms of primary syphilis?

A

Chancre on the genitals (lesion may not be seen in women)Non-tender lymphadenopathy

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75
Q

What are the symptoms of secondary syphilis? (3)

A

Systemic symptoms - fever, lymphadenopathy Rash on trunk, palms and soles Buccal ‘snail track’ ulcers

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76
Q

How long after the primary stage does secondary syphilis develop?

A

6-10 weeks

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77
Q

What is the latent stage of syphilis?

A

Occurs after the secondary stage - the patient becomes asymptomatic despite still being infected with syphilis

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78
Q

When is the early latent stage of syphilis?

A

Within 2 years of initial infection

79
Q

How long do secondary syphilis symptoms last for?

A

3-12 weeks

80
Q

When is the late latent stage of syphilis?

A

From two years after the initial infection onwards

81
Q

What are the features of tertiary syphilis? (3)

A

Gummas (granuloma) Ascending aortic aneurysms General paralysis of the insane Tabes dorsalis Argyll-Robertson pupil ocular syphilis

82
Q

What is tabes dorsalis?

A

demyelination affecting the spinal cord posterior columns

83
Q

What is Argyll-Robertson pupil?

A

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
Q

What are the features of congenital syphilis? (3)

A

Blunted upper incisor teeth Rhagades (linear scars in the skin around the mouth and nose)KeratitisDeafnessSaber shinsSaddle nose

85
Q

What is the first line investigation for syphilis?

A

Screening test - antibody test for antibodies to T. pallidum

86
Q

What further testing can be done in patients suspected of having syphilis?

A

Swabs from infected sites can be processed through: - Dark field microscopy - PCR

87
Q

What is the first line management of syphilis?

A

IM benzanthine benzylpenicillin

88
Q

What is an alternative antibiotic in the treatment of syphilis?

A

Doxycycline

89
Q

What is the Jarisch-Herxheimer reaction?

A

A reaction seen hours after the treatment of spirochete infections due to the release of endotoxins following bacterial death:- Fever, rash and tachycardia

90
Q

What are the signs of congenital syphilis? (3)

A

Generalised lympadenopathyHepatosplenomegaly Rash Skeletal malformations

91
Q

What type of virus is HIV?

A

HIV is an RNA retrovirus

92
Q

What is the most common type of HIV?

A

HIV-1

93
Q

What type of HIV is mainly found in Western Africa?

A

HIV-2

94
Q

What is the pathophysiology of HIV?

A

The virus enters and destroys the CD4 T helper cells of the immune system

95
Q

How can HIV be transmitted? (3)

A

Unprotected anal, vaginal or oral sex Vertical transmission Exposure to infected bodily fluids

96
Q

How does HIV replicate inside the body?

A

Once in the T helper cells, it uses the enzyme reverse transcriptase to convert viral RNA into a DNA copy

97
Q

What is HIV seroconversion?

A

When the body starts to produce antibodies to HIV- After seroconversion, HIV can be tested for

98
Q

What are the symptoms of HIV seroconversion? (5)

A

Flu-like illness symptoms - Sore throat- Lymphadenopathy - Diarrhoea - Malaise, myalgia - Maculopapular rash - Mouth ulcers

99
Q

How long after infection does seroconversion occur?

A

3-12 weeks

100
Q

What are the risk factors for HIV infection? (3)

A

IV drug use Homo and heterosexual unprotected intercourse Percutaneous needlestick injuryHaving another STI

101
Q

What methods are used to diagnose HIV?

A

HIV antibodies p24 antigen

102
Q

How are HIV antibodies used to diagnose HIV?

A

ELISA test and a confirmatory Western Blot assay are used to detect antibodies to HIV

103
Q

After how long can HIV antibodies be detected in the blood?

A

Most people have antibodies by 4-6 weeks, but 99% of people have antibodies by 3 months

104
Q

How are p24 antigens used to diagnose HIV?

A

A viral core protein can be detected as RNA viral levels increase in the blood

105
Q

When can p24 antigens be detected in the blood?

A

Between 1 weeks and 3-4 weeks after infection

106
Q

How are most people diagnosed with HIV?

A

A test combining p24 antigen testing and HIV antibodies

107
Q

When should an asymptomatic patient be offered testing after a possible HIV exposure?

A

4 weeks after the exposure - Repeated at 12 weeks if first test is negative

108
Q

What are the differentials of HIV infection? (3)

A

Infectious mononucleosis CMV InfluenzaViral hepatitis Secondary syphilis

109
Q

What is the normal CD4 count range?

A

500-1200 cells/mm3

110
Q

Under what CD4 count puts a patient at risk of opportunistic infections?

A

200

111
Q

What is the main treatment of HIV?

A

Anti-retroviral treatment

112
Q

Who is antiretroviral treatment offered to?

A

All patients regardless of CD4 count - ART should be started as soon as a HIV diagnosis is made

113
Q

What are the classes of ART?

A

Protease inhibitors Integrase inhibitors Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitorsEntry inhibitors

114
Q

What is the usual starting regime for HIV treatment?

A

Two NRTIs plus an additional drug

115
Q

What additional management is required in HIV? (3)

A

Prophylactic co-trimoxazole for patients with CD4 count under 200Yearly cervical smears Up to date vaccinations

116
Q

When can a woman with HIV have a normal vaginal birth?

A

If viral load is under 50

117
Q

What drug can be given to a woman in labour to prevent the vertical transmission of HIV?

A

IV zidovudine

118
Q

What prophylaxis may be given to a baby with a HIV positive mother?

A

Zidovudine for 4 weeks

119
Q

What is the safest advice to breastfeeding mothers that are HIV positive?

A

To avoid breastfeeding - HIV can be transmitted through breast milk

120
Q

What is PEP?

A

Post exposure prophylaxis - Given within 72 hours to patients who have been exposed to HIV

121
Q

What is the current combination of drugs used in PEP?

A

emtricitabine/tenofovir (Truvada) and raltegravir for 28 days

122
Q

What is PrEP?

A

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
Q

What is the current combination of drugs used in PrEP?

A

emtricitabine/tenofovir (Truvada)

124
Q

What are the most common AIDS defining illnesses? (4)

A

Kaposi’s sarcoma Pneumocystis jirovecii pneumonia Cytomegalovirus infection Candidiasis Lymphomas TB

125
Q

When should children be tested for HIV? (3)

A

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
Q

What eye conditions may be seen in someone with HIV? (3)

A

CMV retinitis Kaposi’s sarcoma HSV infection VSV infection Tuberculosis

127
Q

What is the presentation of CMV retinitis?

A

Reduced visual acuity
Pizza pie appearance on fundoscopy - areas of thick white infiltrate accompanied by retinal haemorrhages

128
Q

What is the treatment of CMV retinitis?

A

Intra-ocular ganciclovir Oral valganciclovir

129
Q

What is Kaposi’s sarcoma?

A

A cancer caused by HSV-8 commonly seen in patients with HIV

130
Q

Where does Kaposi’s sarcoma develop from?

A

Endothelial cells - It is seen in the skin

131
Q

What is the appearance of Kaposi’s sarcoma?

A

Purple papules or plaques on the skin

132
Q

What is the treatment of Kaposi’s sarcoma?

A

Radiotherapy Resection

133
Q

What types of cancers is HIV associated with? (3)

A

AnalLiverLung Hodgkin’s lymphoma Burkitt’s lymphoma Kaposi’s sarcoma

134
Q

What is the treatment of pneumocystis jiroveci pneumonia?

A

Co-trimoxazole

135
Q

What are the features of pneumocystis jiroveci pneumonia? (3)

A

Bilateral bihilar interstitial infiltrates Desaturating on exertion Non-productive cough Poorly controlled HIV

136
Q

How should anti-retrovirals be taken?

A

They should be taken at the same time every day

137
Q

What are genital warts caused by?

A

HPV infection

138
Q

Which types of HPV most commonly cause genital warts?

A

HPV 6 and 11

139
Q

What are the features of genital warts? (3)

A

Small fleshy protuberences that are slightly pigmented Lesions may bleed or itch

140
Q

What are the risk factors for genital warts? (3)

A

Not vaccinated against HPV Earlier sexual intercourse Increasing number of lifetime sexual partners Immunocompromised Unprotected sex

141
Q

How are genital warts transmitted?

A

Mostly through skin to skin contact during sexual intercourse

142
Q

How are genital warts diagnosed?

A

Mostly clinical diagnosis - can be confirmed with a biopsy

143
Q

What is the first line treatment of genital warts?

A

Topical podophyllum Cyrotherapy

144
Q

What is the second line treatment of genital warts?

A

Imiquimod cream

145
Q

What is balanitis?

A

Inflammation of the glans penis and prepuce (foreskin)

146
Q

What are the causes of balanitis? (3)

A

Atopic eczema
Allergic contact eczema
Psoriasis
Lichen sclerosis
Candidosis
Gonorrhoea
Carcinoma in situ
Bacterial causes

147
Q

What bacteria most commonly causes balanitis?

A

Staphylococcus species

148
Q

What are the risk factors for balanitis? (3)

A

Uncircumsised
Congenital or acquired dysfuntional foreskin
Poor hygeine
Overwashing
HPV infection
Multiple partners
High risk sexual behaviours

149
Q

What are the features of balanitis? (3)

A

Penile soreness
Dysuria
Itchiness, bleeding, and erythema of the glans penis.

150
Q

How is balanitis diagnosed?

A

Mostly clinically diagnosed- Can confirm with swab microscopy and culture for candida albicans or bacteria

151
Q

What is the general treatment of balanitis? (3)

A

Gentle saline washesWashing properly under the foreskin 1% hydrocortisone cream

152
Q

What is the treatment of balanitis caused by candida?

A

Topical clotrimazole for two weeks

153
Q

What is the treatment of balanitis caused by staphylococcus?

A

Oral flucloxacillin or clarithromycin

154
Q

What is the treatment of balanitis caused by lichen sclerosis?

A

High potency topical steroids

155
Q

What is chancroid?

A

An STI caused by Haemophilus ducreyi

156
Q

Where is chancroid common?

A

Most common in tropical and subtropical resource poor countries

157
Q

What type of bacteria is Haemophilus ducreyi?

A

Gram negative coccobacillus

158
Q

What are the risk factors for chancroid? (3)

A

Unprotected sex High number of sexual partnersSex work Cocaine use Uncircumsised

159
Q

How long after exposure to chancroid do symptoms take to develop?

A

4-10 days

160
Q

What is the presentation of chancroid? (3)

A

Painful genital papules Genital ulcers Bleeding from lesionsPainful lymphadenopathy

161
Q

What are the differentials of chancroid? (3)

A

Syphilis Herpes simplex Lymphogranuloma venereum

162
Q

What investigations can be used to confirm a diagnosis of chancroid?

A

Culture PCRLymph node aspirate culture

163
Q

What is the management of chancroid?

A

Antibiotic treatment - options include:- Azithromycin - Ciprofloxacin - Ceftriaxone

164
Q

What are the 4 classifications of Sexual Disorders?

A

Desire + drive -> hypoactive sexual desire disorder
Arousal -> erectile dysfunction
Orgasm -> ejaculation disorder, female orgasmic disorder
Resolution -> dyspareunia etc

165
Q

What are the 2 criteria for something to be considered as a ‘sexual disorder’?

A

Persistent
- Cause marked distress

166
Q

List some causes of Sexual Disorders.

A

Chronic medical conditions (CVD, T2DM, Obesity)
Hormonal
Iatrogenic
Psychiatric

167
Q

What investigations might you consider if a person presented with a sexual disorder?

A

Full Sexual hx
Examination
Blood tests

168
Q

What blood tests might you consider if a person presented with a sexual disorder? (5)

A

Fasting glucose/lipid ratio
Testosterone
SHBG
Prolactin
TSH
Oestrogen
FBC
GnRH

169
Q

Give some examples of psychological treatments for Sexual Disorders (3)

A

Integrative: psychosexual options and physical treatments
CBT: self growth programme
Psychodynamic: past events, attachments, partner choice
Systemic: interactions and roles in a relationship

170
Q

Describe ‘Hypoactive Sexual Desire Disorder’.

A

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
Q

List some causes of hypoactive sexual desire disorder. (5)

A

Chronic disease: DM, CVD, Anaemia
Hormonal -> hyperprolactinaemia!!!!!, hypothyroid
Iatrogenic - SSRI, OCP, HRT
Psychiatric - Depression, Anxiety, Previous trauma

172
Q

What is the treatment for hypoactive sexual desire disorder?

A

Psychosexual: CBT, Psychodynamic therapy etc
- Medication: Testosterone replacement, Flibanserin (for pre-menopausal women)

173
Q

Define ‘Erectile Dysfunction’.

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

174
Q

List some causes of Erectile Dysfunction (5)

A

Chronic disease: CVD, DM,
Hormonal: Androgen deficiency, prolactin
Iatrogenic: Prostate surgery, SSRIs, HTN
Psychiatric: relationship problems, age, depression

175
Q

What is 1st line treatment for Erectile dysfunction? Side effects? Contraindications?

A

Phosphodiesterase inhibitors (Sildenafil)
SE: Headaches + flushing
CI: Hypotension

176
Q

What is 2nd line treatment for Erectile dysfunction?

A

Alprostadil (injectable or intraurethral via MUSE)

177
Q

List 4 non-medical treatments for Erectile Dysfunction.

A

Vacuum Device
Penile / Scrotal device
Kegel exercises
Psychological

178
Q

Define ‘Female Sexual Arousal Disorder’.

A

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
Q

List the causes of Female Sexual Arousal Disorder (5)

A

Chronic disease: DM, CVD,
Hormonal: oestrogen deficiency
Iatrogenic: SSRIs
Lactation
Psychological

180
Q

What is the treatment for Female Sexual Arousal Disorder?

A

Behavioural: senate focus
- Psychosexual couples therapy

181
Q

Define rapid ejaculation.

A

Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction.
Ejaculation occurring within 1 minute

182
Q

Causes of rapid ejaculation? (3)

A

Genetic susceptibility
Hyperthyroidism
Penile hypersensitivity
Psychological (performance anxiety, inexperience)

183
Q

Treatment for rapid ejaculation? (3)

A

1st line: SSRIs: Dapoxetine (increases risk of suicide)
STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, kegel exercises)

184
Q

Define ‘Female Orgasmic Disorder’.

A

Orgasm either does not occur or is markedly delayed.

185
Q

List some causes of Female Orgasmic Disorder (3)

A

Chronic disease: DM, CVD, Obesity
Hormonal: hyperprolactinaemia, hypothyroid
Pelvic floor weakness / damage
Ageing
SSRIs
Psychological

186
Q

What is the treatment for Female Orgasmic Disorder? (2)

A

Topical oestrogen
- Behavioural interventions: guided masturbation, vibrators

187
Q

Define ‘vaginismus’.

A

Spasm of the pelvic floor muscles that surround the vaginal opening.
Makes penile entry painful or impossible.

188
Q

Causes of vaginismus? (3)

A

Thrush, FGM, congenital abnormality
- Psychological: previous trauma / abuse; fear / dislike of partner or pregnancy

189
Q

Treatment for vaginismus? (2)

A

Psychosexual
- Behavioural: self exploration, vaginal dilators, graded penetration therapy

190
Q

Define ‘dyspareunia’.

A

Pain during intercourse
Often due to local pathology
This category is used ONLY if there is no primary non-organic sexual dysfunction

191
Q

List causes for Female dyspareunia (3)

A

Superficial: STIs, episiotomies, vaginal atrophy
Deep: PID, endometriosis

192
Q

List causes for male dyspareunia (3)

A

STIs, Urethral strictures, Varicoceles
Psychological
Relationship causes (poor technique of partner)

193
Q

What are the treatments for dyspareunia? (3)

A

Lubricants
Couples therapy
Behavioural therapy
?Refer to gynae

Phase 3a🩺 (12 decks)

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