Sexual Health - Peer Teaching Flashcards
What are the 4 classifications of Sexual Disorders?
- Desire + drive -> hypoactive sexual desire disorder
- Arousal -> erectile dysfunction
- Orgasm -> rapid ejaculation, female orgasmic disorder
- Resolution -> dyspareunia etc
What are the 2 criteria for something to be considered as a ‘sexual disorder’?
- Persistent
- Cause marked distress
List some causes of Sexual Disorders.
- Chronic medical conditions (CVD, T2DM, Obesity)
- Hormonal
- Iatrogenic
- Psychiatric
What investigations might you consider if a person presented with a sexual disorder?
- Full Sexual hx
- Examination
- Blood tests
What blood tests might you consider if a person presented with a sexual disorder?
- Fasting glucose/lipid ratio
- Testosterone
- SHBG
- Prolactin
- TSH
- Oestrogen
- FBC
- GnRH
Give some examples of psychological treatments for Sexual Disorders.
- Integrative: psychosexual options and physical treatments
- CBT: self growth programme
- Psychodynamic: past events, attachments, partner choice
- Systemic: interactions and roles in a relationship
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
List some causes of hypoactive sexual desire disorder.
- Chronic disease: DM, CVD, Anaemia
- Hormonal -> hyperprolactinaemia!!!!!, hypothyroid
- Iatrogenic - SSRI, OCP, HRT
- Psychiatric - Depression, Anxiety, Previous trauma
What is the treatment for hypoactive sexual desire disorder?
- Psychosexual: CBT, Psychodynamic therapy etc
- Medication: Testosterone replacement, Flibanserin (for pre-menopausal women)
Define ‘Erectile Dysfunction’.
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
List some causes of Erectile Dysfunction.
- Chronic disease: CVD, DM,
- Hormonal: Androgen deficiency, prolactin
- Iatrogenic: Prostate surgery, SSRIs, HTN
- Psychiatric: relationship problems, age, depression
What is 1st line treatment for Erectile dysfunction?
Side effects?
Contraindications?
Phosphodiesterase inhibitors (Sildenafil)
SE: Headaches + flushing
CI: Hypotension
What is 2nd line treatment for Erectile dysfunction?
Alprostadil (injectable or intraurethral via MUSE)
List 4 non-medical treatments for Erectile Dysfunction.
- Vacuum Device
- Penile / Scrotal device
- Kegel exercises
- Psychological
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
List the causes of Female Sexual Arousal Disorder
Chronic disease: DM, CVD, Hormonal: oestrogen deficiency Iatrogenic: SSRIs Lactation Psychological
What is the treatment for Female Sexual Arousal Disorder?
- Behavioural: senate focus
- Psychosexual couples therapy
Define rapid ejaculation.
- Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction.
- Ejaculation occurring within 1 minute
Causes of rapid ejaculation??
- Genetic susceptibility
- Hyperthyroidism
- Penile hypersensitivity
- Psychological (performance anxiety, inexperience)
Treatment for rapid ejaculation?
1st line: SSRIs: Dapoxetine (increases risk of suicide)
STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, kegel exercises)
Define ‘Female Orgasmic Disorder’.
Orgasm either does not occur or is markedly delayed.
List some causes of Female Orgasmic Disorder.
Chronic disease: DM, CVD, Obesity Hormonal: hyperprolactinaemia, hypothyroid Pelvic floor weakness / damage Ageing SSRIs Psychological
What is the treatment for Female Orgasmic Disorder?
- Topical oestrogen
- Behavioural interventions: guided masturbation, vibrators
Define ‘vaginismus’.
- Spasm of the pelvic floor muscles that surround the vaginal opening.
- Makes penile entry painful or impossible.
Causes of vaginismus?
- Thrush, FGM, congenital abnormality
- Psychological: previous trauma / abuse; fear / dislike of partner or pregnancy
Treatment for vaginismus?
- Psychosexual
- Behavioural: self exploration, vaginal dilators, graded penetration therapy
Define ‘dyspareunia’.
- Pain during intercourse
- Often due to local pathology
- This category is used ONLY if there is no primary non-organic sexual dysfunction
List causes for Female dyspareunia.
Superficial: STIs, episiotomies, vaginal atrophy
Deep: PID, endometriosis
List causes for male dyspareunia.
- STIs, Urethral strictures, Varicoceles
- Psychological
- Relationship causes (poor technique of partner)
What are the treatments for dyspareunia?
- Lubricants
- Couples therapy
- Behavioural therapy
- ?Refer to gynae
What are the risk factors for Candida Albicans infection?
- Pregnancy
- DM
- Antibiotics
How might a patient with Candida Albicans present?
- Cottage cheese discharge
- Itching
- Soreness
- Red
What investigations should you do if you suspect candida albicans?
- Clinical diagnosis
- MC+S show Mycelia spores
What is the treatment for candida albicans?
Antifungals!
- Clotrimazole (cream) or;
- Oral fluconazole
What are the risk factors for bacterial vaginosis?
- Sexually active
- IUCD
- New partner
How might bacterial vaginosis present?
- 50% symptomatic
- White, fishy smelling discharge
How would you investigate a suspected bacterial vaginosis?
- Vaginal pH > 4.5
- Clue cells
- Positive whiff test(!)
What is the treatment for bacterial vaginosis?
Metronidazole
Which organism causes Gonorrhoea?
Neisseria gonorrhoea
Gram -ve diplococcus
Risk factors for Gonorrhoea?
- Previous STI
- Multiple sexual partners
How might Gonorrhoea present?
Males: 90% asymptomatic
Females: 50% asymptomatic
- discharge
- dysuria
What investigation should you do for Gonorrhoea?
NAAT
What is the treatment for Gonorrhoea?
- IM Ceftriaxone
- Oral Azithromycin to cover for Chlamydia
- CONTACT TRACING
Which organism causes Chlamydia?
Chlamydia Trachomatis
Gram -ve
*the most common STI
What are the risk factors for Chlamydia?
- Previous STI
- Multiple sexual partners
How might Chlamydia present?
50% females are asymptomatic
- discharge
- dysuria
- intermenstrual bleeding
What diseases is Chlamydia associated with?
- PID
- Reiter’s (conjunctivitis, urethritis, reactive arthritis)
How should you investigate a ?chlamydia?
- NAAT
- Swabs
What is the treatment for Chlamydia?
- Oral Azithromycin
- CONTACT TRACING!!
Describe trichomonas vaginalis.
Flagellated protozoan
How might trichomonas vaginalis present?
50% asymptomatic
- frothy, offensive smelling yellow/green discharge
- Strawberry cervix
- Dysuria
- Itchy
- Sore
How might you investigate for ?trichomonas vaginalis?
- NAAT
- Swabs
How would you treat trichomonas vaginalis?
- Metronidazole
- Treat partner concurrently
Which organism causes genital warts?
Human Papilloma Virus (HPV 6 / 11)
List some risk factors for genital warts
- Smoking
- Multiple partners
- Early age intercourse
How might genital warts present?
- Growths / lesions
- Multiple / solitary
- Painless
- Itchy
- Dyspareunia
What should you do on diagnosing genital warts?
Opportunistic STI screen
What is the treatment for genital warts?
- Cryotherapy
- Podophyllotoxin cream
A 42yo homosexual man presents to his GP because he is concerned about his erection. He has no committed partner at the moment. What 4 conditions should cause these symptoms in a man of his age?
- CVD
- T2DM
- Obesity
- Anaemia
- Hypothyroid
- Depression
A 42yo homosexual man presents to his GP because he is concerned about his erection. He has no committed partner at the moment.
Name 2 metabolic / endocrine investigations you would like to perform on this man.
- Fasting glucose/lipid ratio
- Testosterone
- SHBG
- Prolactin
- TSH
- GnRH
A 42yo homosexual man presents to his GP because he is concerned about his erection. He has no committed partner at the moment.
Further in the consultation is becomes evident that there is an element of performance anxiety.
Name 2 psychosocial interventions that the patient could do to reduce this anxiety.
- CBT
- Psychodynamic therapy
- Integrative therapy
- Systematic therapy
A 42yo homosexual man presents to his GP because he is concerned about his erection. He has no committed partner at the moment.
How would the man’s homosexuality affect treatment?
- Needs HIV / Hep B / Hep C screening
A lady is having her first cervical smear. She is very anxious about having a genital examination. What 3 things need to be done before the examination?
- Explain
- Consent
- Chaperone
A lady is having her first cervical smear. She is very anxious about having a genital examination.
She has never been penetrated and is referred to psychosexual therapy.
Name 4 psychosocial therapy treatments.
- CBT
- Systematic therapy
- Integrative therapy
- Psychodynamic therapy
A lady is having her first cervical smear. She is very anxious about having a genital examination.
She has never been penetrated and is referred to psychosexual therapy. Name 3 behavioural interventions.
- Graded penetration therapy
- Self exploration
- Vaginal dilator
45 yo lady with hypoactive sexual desire disorder for the last 2 years. Name 4 investigations (endocrine / metabolic).
- TFTs
- Prolactin
- GnRH
- SHBG
- Oestrogen
- Lipid/glucose ratio
45 yo lady with hypoactive sexual desire disorder for the last 2 years.
Give 2 non-metabolic causes.
- Depression
- Anxiety
45 yo lady with hypoactive sexual desire disorder for the last 2 years.
Name 2 effects HSDD can have on her partner.
- Depression
- Performance anxiety -> erectile dysfunction
45 yo lady with hypoactive sexual desire disorder for the last 2 years.
Give 2 possible treatment options
- Psychodynamic / couple therapy
- Behavioural therapy
- Flibanserin (for pre-menopausal women with HSDD).
