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Phase 3A HH > Sexual Medicine > Flashcards

Sexual Medicine Flashcards

1
Q

What are the two main features of hypoactive sexual desire disorder (HSDD)?

A

Lack or loss of sexual desire CAUSING distress - primary prob. Doesn’t mean can’t have sexual enjoyment or arousal, but makes initiation of sexual activity less likely.

Persistently/recurrently deficient (or absent) sexual/erotic thoughts or fantasies desire for sexual activity.

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2
Q

Aetiology of hypoactive sexual desire disorder (HSDD)

A

Chronic diseases e.g. obesity, CVD, DM, anaemia
Hormonal disorders (androgen defic., hypogonadism, hyperprolactinaemia, hypothyroidism, post-preg, Addison’s disease)
Iatrogenic: prescribed meds (SSRIs, finasteride (for BPH), oral contraceptive, HRT, tamoxifen (all of these bind with testosterone), surgery)
Psych (depression, anxiety, substance misuse, prev trauma, relationship probs

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3
Q

HSDD treatment options

A

Psychosexual therapy - CBT, psychodynamic, cognitive, integrative, behavioural
Medication - testosterone replacement (Flibanserin if pre menopausal women)

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4
Q

Define erectile dysfunction

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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5
Q

Aetiology of erectile dysfunction

A

Physiological:

  • Chron med conds (CVD, DM, neurological disease)
  • Hormonal disorders
    e. g. androgen defic., high prolactin
  • Iatrogenic e.g. post prostate surgery, SSRIs, HTN
  • Age related
  • Ineffective sexual stimuli
  • Pain
  • Veno-occlusive disorder

Psychological:

  • Psych conds e.g. depression, substance misuse
  • Couples script problems
  • Relationship problems or issues from previous relationship
  • Educational matters
  • Cultural and Religious matters
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6
Q

Medication for erectile dysfunction

A

1st line - phosphodiesterase inhibitors e.g. sildenafil (viagra). S/E: headaches and flushing
2nd line: alprostadil (injectable or intraurethral via MUSE - medical urethral system for erection)

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7
Q

Non-medical treatment for ED

A

Vacuum device
Penile/scrotal rings
New stimulating routines e.g. enhancing lubricants, vibrators
Kegel exercises
Psychological treatment (CBT, integrative, psychodynamic, systemic)

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8
Q

Define female sexual interest/arousal disorder (FSAD)

A

Failure of genital response - main problem is vaginal dryness or failure of lubrication.
Reduced sexual interest/arousal:
Absent/reduced interest in sexual activity
Absent/reduced sexual/erotic thoughts or fantasies
Absent/reduced sexual pleasure
Absent/reduced sexual arousal in response to sexual stimuli

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9
Q

Aetiology of FSAD

A

-Chron med conds e.g. CVD, DM, neurological disease, connective tissue disease
-Hormonal disorders - oestrogen deficiency, e.g. post menopause
-Iatrogenic - SSRIs
-Lactation
-Vaginal dryness is a common presenting problem and can also be caused by local irritants and douching
Psychological - depression, eating disorders, relationship probs

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10
Q

General causes of sexual disorders

A

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

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11
Q

General investigations for sexual disorders

A

Full sexual history
Exam
Blood tests: Fasting glucose/lipid ratio, testosterone, SHBG,p prolactin, TSH, oestrogen, FBC, GnRH

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12
Q

General psychological treatments for sexual disorders

A

Integrative - combination of psychosexual options and physical treatments
CBT - sensate focus or self growth programme
Psychodynamic - past events, attachments, partner choice
Systemic - interactions and roles in a relationship

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13
Q

Treatment for FSAD

A

Behavioural: sensate focus, eros therapy device, lubricants

Psychosexual couples therapy

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14
Q

Define rapid ejaculation

A

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

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15
Q

Aetiology of rapid ejaculation

A

Genetic susceptibility
Hyperthyroidism
Penile hypersensitivity
Psychological (performance anxiety, lack of experience, issues, early experience)

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16
Q

Treatment of rapid ejaculation

A

1st line - SSRIs : dapoxetine (increased risk of suicide), STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, Kegel exercises)

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17
Q

What is female orgasmic disorder

A

Orgasm does either not occur or is markedly delayed

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18
Q

Causes of female orgasmic disorder

A

Chronic disease (DM, CVD, anaemia, obesity)
Hormonal (androgen deficiency, hyperprolactinaemia, hypothyroid)
Pelvic floor weakness, damage
Ageing
SSRIs
Psychological (abuse, relationship problems)

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19
Q

Treatment of female orgasmic disorder

A

Topical oestrogens

Behavioural interventions - guided masturbation, vibrators

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20
Q

What is vaginismus?

A

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

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21
Q

Causes of vaginismus

A

Thrush, FGM, congenital abnormality

Psychological: previous trauma/abuse, fear/dislike partner or pregnancy

22
Q

Treatment of vaginismus

A

Psychosexual

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

23
Q

Define dyspareunia.

A

Pain during intercourse. Often due to local pathology

ONLY used if no primary non-organic sexual dysfunction.

24
Q

Causes of dyspareunia

A

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

Male:
STIs, urethral stricturesm, varicocoeles
Psychological
Relationship causes (poor technique of partner)

25
Q

Treatment of dyspareunia

A

Lubricants
Couples therapy
Behavioural therapy
Poss refer to gynae

26
Q

Presentation of candida albicans (thrush)

A 
Cottage cheese discharge - thick, creamy, odourless
Itching
Soreness
Redness
Dyspareunia
Dysuria
27
Q

Risk factors for candida albicans (thrush)

A

Pregnancy, DM, Abx, chemo, HIV, vaginal dryness

28
Q

Investigations for candida albicans (thrush)

A

Clinical diagnosis, MC+S - show Mycelia spores

29
Q

What is candidiasis?

A

Common yeast infection, NOT STI
Caused by candida albicans - frequently present in normal vagina but kept under control by other bacteria, so only symptomatic when immunosuppressed.

30
Q

Treatment for candidiasis

A

General advice:
Vulval moisturiser as soap substitute
Avoid tight fitting synthetic clothing
Avoid local irritants like perfumed products

Pharm:
Antifungals - Topical clotrimazole cream stat, clotrimazole pessary if more severe, oral fluconazole (avoid in preg and breastfeeding)

No rx needed for male partner

31
Q

What is bacterial vaginosis?

A

Commonest cause of abnormal vaginal discharge.
Normal balance of organisms in the vagina disrupted (e.g. due to vaginal douching) - anaerobes like gardnerella vaginalis take over

32
Q

Presentation of bacterial vaginosis?

A

50% symptomatic - white, fishy smelling discharge
No soreness/itchiness
Thin white discharge coating vaginal wall

33
Q

Investigations and diagnosis for BV?

A

Diagnosis by Amsel’s criteria (need 3 out of 4): thin, white discharge, CLUE cells, whiff test +ve, pH>4.5
Also Gram stained vaginal smear - look for gardnerella/lactobacillus

34
Q

Risk factors for BV?

A

sexually active, IUCD, new partner

35
Q

Management of BV?

A

Metronidazole single dose
Treat pregnant women same way
No screening or treatment needed for male partners

36
Q

What is trichomonas vaginalis?

A

STI - caused by T. Vaginalis (flagellated protazoan)

37
Q

Presentation of TV?

A 
50% asymptomatic.
Frothy, offensive smelling, yellow/green discharge
Strawberry cervix
Dyspareunia
Dysuria
Itchiness/soreness
38
Q

Ix for TV?

A

Vaginal swab for immediate microscopy (w/in 10 mins so trichomonas still motile)
First void urine for NAAT (nucleic acid amplification testing)

39
Q

Management for TV?

A

Metronidazole 2g stat
Treat pregnant women the same (some prefer delay of rx until 2nd trimester) - affects taste of breast milk, so use low dose.

NEEDS ABSTINENCE for at least 1 week post stat dose of metronid.

Treat sexual partner(s)

40
Q

What is chlamydia?

A

Most common curable STI in UK. Highest prev in 15-24 yo, high freq. of transmission.
Caused by chlamydia trachomatis
If untreated, can resolve (50%) but can also –> PID, infertility

41
Q

Diagnosis of chlamydia?

A

Vulvovaginal swab and first-catch urine then NAAT

42
Q

Risk factors for chlamydia?

A

Previous STI, multiple partners

43
Q

Presentation of chlamydia?

A

Majority asyptomatic.
Discharge, dysuria, IMB & PCB, deep dyspareunia, lower abo pain.
Signs: cervicitis, cervical motion tenderness, pelvic tenderness.

44
Q

Complications of chlamydia?

A

PID, Reiters (conjunctivitis, urethritis, reactive arthritis - can’t see, can’t pee, can’t climb a tree), infertility

45
Q

Management of chlamydia?

A

Pharm:
Azithromycin 1g oral stat
OR doxycycline 100mg BD for 7 days (not in preg)
ABSTINENCE UNTIL 1 week after stat dose.
Advise safe sex and contraception
CONTACT TRACING - advise partners to do full STI screen (HIV inclusive)

46
Q

What is gonorrhoea?

A

STI - caused by gram -ve diplococcus Neisseria Gonorrhoea.
Infection site: endocervix, rectum, pharynx, urethra, conjunctiva.
Risk factors: previous STI, multiple partners.

47
Q

Presentation of gonorrhoea?

A

90% men & 50% women asymptomatic.

Discharge, dysuria

48
Q

Investigations for gonorrhoea?

A

NAAT, microscopy (gram neg diplococci within polymorphnucear leukocytes), culture.

49
Q

Management for gonorrhoea?

A

Pharm: azithromycin 1g oral stat (covering for chlamydia) AND ceftriaxone 500mg IM stat
ABSTINENCE until 1 week after stat dose
CONTACT TRACING
Advise safe sex and contraception

50
Q

Causes and risk factors of genital warts?

A

HPV 6 & 11 (now vaccinated against) - don’t usually cause cervical cancer. Risk factors: smoking, multiple partners, early age intercourse

51
Q

Presentation of genital warts?

A

Growths/lesions, multiple/solitary, painless, itch, dyspareunia

52
Q

Diagnosis and treatment of genital warts?

A

Dx: STI screen
Rx: cryotherapy, podophyllotoxin cream

Phase 3A HH (6 decks)

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