Sexual Medicine Flashcards
What are the four stages of the sexual response cycle?
- Desire (libido)
- Arousal (excitement)
- Orgasm (climax)
- Resolution
What is a sexual disorder?
Difficulty, either by an individual or a couple, during any stage of normal sexual activity.
It must cause the individual/couple extreme distress, and be persistent for a minimum of 6 months.
For something to be classed as a sexual disorder what 2 things does it need to be to be?
- It must cause the individual/couple extreme distress
2. Be persistent for a minimum of 6 months.
What is erectile dysfunction?
The inability to develop or maintain an erection of the penis during sexual activity
List two psychological causes of ED
Any 2 of the following;
- Stress
- Depression
- Performance anxiety
- Relationship issues
Script issues
List two medical conditions that can cause of ED
Any 2 of the following;
- ATHEROSCELROSIS - obesity, smoking
- DIABETES MELLITUS
- Cardiovascular disease
- Kidney failure
- Hormone imbalance
- Neurological problems such as MS, trauma to the nerves
- Peyronie’s disease
Name 2 investigations that you would want to do on a patient presenting with ED
Any of the following investigations may be appropriate;
- Glucose / lipid profile (diabetes, obesity, cholesterol)
- Blood pressure
- Hormone levels (testosterone, prolactin)
- Physical examination
- Blood tests
What is the first line medication currently used to treat ED?
What is its mechanism of action?
Viagra (Sodenafil)
PDE 5 inihibitor
List 1 device that can be used to treat ED
- Vacuum/penis pump
- Penile/Scrotal rings
Give 3 pieces of lifestyle advice to someone with ED
- Exercise (increase blood flow and prevent/slow atherosclerosis)
- Lose weight (if patient is overweight)
- Stop smoking
- Reduce alcohol consumption
What is premature ejaculation?
- A sexual arousal disorder
- An male orgasm that occurs before their partner achieves orgasm / mutually satisfactory length of time has passed during intercourse (generally ejaculation that occurs in under 2 minutes of penis insertion).
List 1 medical condition and one psychological condition that can cause premature ejaculation
- Thyroid problem (whether this be over or underactive)
- Depression
- Performance anxiety
- Relationship issues
What is retrograde ejaculation?
When semen travels back into the bladder instead of the urethra.
How could you test for retrograde ejaculation?
- Patient history - reports little to no ejaculation during orgasms
- Urine sample (check for semen), cloudy urine - sample should be from urine produced immediately after sex
- Scans
What is the main problem caused by retrograde ejaculation?
Can affect the ability to have a child (does not affect the ability to orgasm or enjoy a healthy sex life).
Usually individuals do not need treatment unless they are wanting to father a child - IVF or artificial insemination.
What is dyspareunia?
- Pain during intercourse
- Pain disorder
List 3 medical causes of female dyspareunia (superficial)
Any of the following 3;
- Episiotomies
- Lack of sexual arousal
- Vaginismus
- Genital irritation – latex condoms, products
- Vaginal Atrophy
- Insufficient lubrication (vaginal dryness) – menopause
- Infection: STI, thrush
List 2 medical causes of female dyspareunia (deep)
Any of the following 2;
- PID
- Endometriosis
- IBS
- Constipation
List 2 medical causes of dyspareunia in men
Any of the following 2;
- Infection: STI’S, thrush
- Urethral strictures
- Prostatitis
- Varicoceles
List 2 psychological causes of dyspareunia
Any 2 of the following;
- Poor partner technique
- Anxiety / stress
- Previous trauma e.g. bad first experience, rape
How would you treat dyspareunia?
Depends on the cause!
- Lubrication
- Couples therapy
- Behavioural therapy
- Testing and treatment for STI
What is vaginismus?
Involuntary spasm of the pelvic floor muscles that surround the vaginal opening.
Spasms make penile entry painful and/or impossible.
List 1 medical cause of vaginismus
Any of the following;
- Thrush
- FGM
- Congenital abnormalities
List 1 psychological cause of vaginismus
Any of the following;
- Previous trauma/abuse
- First bad sexual experience
- Fear or dislike of partner or pregnancy
What treatment exists for vaginismus?
- Vaginal trainers: objects of different sizes that can be inserted into the vagina and gradually help to widen it and allow the patient to become used to having things in the vagina
- Pelvic floor exercises
- Psychosexual therapy
What is Peyronie’s disease?
Extreme curving of the penis during erection
List some psychological therapies
- Sensate focus
- Personal sexual growth programme
Hormone tests
- TSH
- Oestrogen
- Testosterone
- Free andoregn index
- GnRH
- LH
- FSH
- Prolactin
What are the principles of couples therapy?
- Create a working alliance with the couple
- Offer insight and understanding into their problems
- Facilitate more effective communication
- Chaneg dysfunctional theought patterns
Woman presents with grey, thin, fishy smelling discharge. You take a swab and look under the microscope. What are you expecting to see? What would you expect the pH of the sample to be?
CLUE CELLS - BV.
pH > 4.5
How do you treat BV?
Metronidazole
How do you treat trichomonas?
Metronidazole
List 4 groups at risk of HepB
Homosexual men
Injecting drugs
High risk areas - africa, asia, eastern europe
Commercial sex workers and their partners
List 2 complications associated with chlamydia infection
- PID
- Reiters syndrome
A woman was diagnosed with chlamydia 2 weeks ago. She has now developed conjuncitivis and a very sore, swollen left knee. What is the most likely diagnosis?
Reiters syndrome
Is HIV a notifiable disease?
No
Is HIV the same as AIDs - what is the difference?
CD4 count < 200 = AIDs.
HIV is the virus.
AIDs is the state of the immune system.
A lady has recently been diagnosed with pneumonia and has been taking ciprofloxacillin. She presents to you complaining of an itchy vulva. What is the most likely diagnosis?
CANDIDA - can follow use of broad spectrum antibitoics.
