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Phase 3a > Sexual Medicine > Flashcards

Sexual Medicine Flashcards

1
Q

What are the psychological causes of HSDD?

A

Psychiatric conditions eg depression, anxiety, substance misuse
Psychological experiences eg trauma/abuse, work stressors
Couple script problems
Couple relationship problems
Body image disorder
Erotic dissatisfaction

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2
Q

What is hypoactive sexual desire disorder?

A

Lack of sexual desire as the primary problem – not due to a secondary problem eg ED or dyspareunia

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3
Q

What are the physical causes of HSDD?

A

Chronic medical condition eg CVD, diabetes, anaemia
Hormone disorder eg androgen deficiency, hyperprolactinaemia
Male: Hypogonadism
Female: Hypothyroidism, Addison’s disease, Post-pregnancy

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4
Q

What investigations need to be done for HSDD?

A

Early morning, fasting testosterone sample (2 samples <12 required for treatment)

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5
Q

What are the treatment options for HSDD?

A

Physical: Testosterone replacement (injection/patch)
Psychological:
Behavioural eg Sensate focus or sexual growth programmes
Psychotherapy eg psychodynamic, CBT, systemic, integrated
Sexual education

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6
Q

What is Erectile Disorder?

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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7
Q

What are the physical causes of ED?

A

Chronic medical condition eg diabetes, CVD, neurological condition
Hormone disorder eg androgen deficiency, hyperprolactinaemia
Enlarged prostate, hypogonadism
Iatrogenic eg post-prostate surgery, antihypertensives (thiazide like diuretic, ARB, β-blocker), Antidepressants (SSRI)
Pain
Age-related changes
Veno-occlusive disorder

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8
Q

What is veno-occlusive disorder

A

Inability of the blood to be trapped inside the penis, in the presence of good arterial supply of blood, in order for it to maintain it’s rigidity.

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9
Q

What are the psychological causes of ED?

A

Psychiatric conditions eg depression, substance misuse
Performance anxiety – more often now due to pornography
Abuse
Trauma eg surgical trauma
Stress
Couples script problems
Couples relationship problems eg disharmony, lack of trust
Partner issues eg pain, vaginismus

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10
Q

How is ED treated?

A

Medical

  • 1st line: Sildenafil (Viagra) + one other eg Tadalafil (Cialis)
  • Alprostadil (injectable/intraurethral)

Non-medical

  • Vacuum pump
  • Penile/scrotal rings
  • Lubricants
  • Kegel exercise
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11
Q

Benefits of Taladafil

A

Daily dose – allows for spontaneity
36 hour half life
Lowers urinary tract symptoms
Reduces performance anxiety

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12
Q

Contraindications of sildenafil

A

Hypotension (<90mmHg)
Recent unstable angina
Recent MI
Recent stroke

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13
Q

Education regarding ED medications

A

They need sexual stimulation to work
Best taken on an empty stomach – but with a glass of water to prevent a hypotensive event
Increasing efficacy up to 8th dose
They take 45-60 minutes to work

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14
Q

What type of things are worked on in couple psychosexual therapy?

A

Communication and vocalisation
Normalising
Education
Permission giving

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15
Q

What is rapid ejaculation?

A

The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction

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16
Q

What are the physical causes of rapid ejaculation?

A 
Genetic susceptibility
Penile hypersensitivity
Hyperthyroidism
Prostatitis/urethritis
Comorbid sexual problems eg ED
Sympathomimetic medication eg beta agonists, dopamine agonists
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17
Q

What are the psychosexual causes of rapid ejaculation?

A 
Anxiety
Inexperience/infrequency sexual activity
Couple relationship problems
Couple script problems
Environmental factors
Partner issue eg pain
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18
Q

What are the treatments for rapid ejaculation?

A

Physical
Topical local anaesthetic eg stud 100 spray with lidocaine
Dapoxetine (SSRI)

Psychosexual
Behavioural eg Sensate focus, start-stop technique, kegel exercises
Psychotherapy

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19
Q

What is sensate focus?

A

A staged programme of exercises to enable the couple to identify own and others sexual likes/dislikes and explore new techniques.
It works with the therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour.

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20
Q

What is delayed ejaculation?

A

Marked delay in ejaculation in almost all occasions (75-100%), either generalised or situational and without the desire to delay

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21
Q

What are the physical causes of delayed ejaculation?

A

Anatomical: Congenital disorder, Trauma/surgery, Retrograde ejaculation
Neurological condition eg peripheral neuropathy (DM), spinal cord injury, alcohol neuropathy
Medications eg SSRIs, thiazide like diuretics, alpha blockers
Hormonal: Low testosterone
Infectious disease

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22
Q

What are the psychosexual causes of delayed ejaculation?

A

Psychiatric conditions eg depression
Insufficient stimulation
Poor masturbation technique
Individual vulnerability factors eg hx of sexual/emotional abuse, poor body image
Couple relationship problems
Partner issues eg pain, ill health, sexual problems
Disguised desire disorder
Secondary to other sexual disorder eg dyspareunia

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23
Q

Investigations for delayed ejaculation?

A

Physical examination
Bloods: FBC, prostate specific antigen, folate and B12, glucose, testosterone
Urine sample: spermatozoa and fructose in retrograde ejaculation

24
Q

What is the treatment of delayed ejaculation?

A 
Treat underlying cause
Personal sexual growth programme
Individual and couple psychotherapy
Kegel exercises
Vibration/superstimulation
25
Q

What is female sexual interest/arousal disorder?

A

Failure of female genital response primarily due to vaginal dryness or failure of lubrication

26
Q

What is the DSM-V criteria for female sexual interest disorder?

A 
3 or more of the following:
Little interest in sex
Few thoughts about sex 
Decreased initiation of sex
Little pleasure during sex
Decreased interest in sex when exposed to erotic stimuli
Little physical response to sex
27
Q

What is the hierarchy of interventions?

A 
Timetabling
Communication
Negotiation/contracting
Addressing intimacy
Being sexual
Adjusting to difficulties
28
Q

What are the physical causes of female sexual interest/arousal disorder?

A

Chronic disease eg diabetes, CVD, neurological/connective tissue disease
Hormone disorder eg low oestrogen (post menopausal or thyroid disorder)
Medications eg SSRIs
Lactation
Irritants/douching

29
Q

What are the psychological causes of female sexual interest/arousal disorder?

A 
Psychiatric conditions eg depression, anxiety, eating disorder
History of abuse
Couples relationship problems
Couples script problems
Decreased intimacy
30
Q

How do you treat female sexual interest/arousal disorder?

A

Couples psychosexual therapy
Behavioural techniques eg Sensate focus, new sexual routines, vibrators
Eros therapy device

31
Q

What is female orgasmic disorder?

A

Orgasm that does not occur or is markedly delayed

32
Q

What are the physical causes of female orgasmic disorder?

A

Chronic medical condition eg CVD, diabetes, neurological disorder, renal/liver disorder
Hormonal disorder eg oestrogen or androgen deficiency, hypothyroidism
Pelvic floor weakness or damage
Ageing
SSRIs (citalopram)

33
Q

What are the psychological causes of female orgasmic disorder?

A 
Psychiatric conditions eg depression, anxiety, substance misuse
History of abuse
Couple script problems
Couple relationship problems
Cultural/religious issues
Lack of understanding
Environmental factors
Stress
34
Q

How can the menopause affect sexual function?

A

Vaginal or pelvic pain
Vaginal Atrophy
Dryness
Change in self image, mood, memory, cognition
Changes in desire
Relationship, psychosocial and health factors play their part
Physical discomfort – sleeplessness, night sweats

35
Q

How do you treat female orgasmic disorder?

A

Physical
Topical oestrogen cream
Medication review

Psychosexual
Psychosexual therapy
Behavioural eg personal sexual growth programme, guided masturbation, lubricants and vibrators, kegel exercises

36
Q

What is vaginismus?

A

Involuntary spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful.

37
Q

What are the physical causes of vaginismus?

A

Thrush
Pain conditions
FGM
Congenital abnormality

38
Q

What are the psychological causes of vaginismus?

A

Mistaken information eg vagina too small, first time will be painful
Fear of pregnancy
History of abuse/trauma of either a sexual experience or gynae examination
Fear or dislike of partner
Relationship dissatisfaction
Situational
Religious/cultural issues

39
Q

How do you treat vaginismus?

A

Individual psychosexual therapy
Integrated CBT
Behavioural interventions eg vaginal trainers, breathing control and relaxation, personal sexual growth programme, kegel exercises, self-exploration and examination

40
Q

What is dyspareunia?

A

Dyspareunia (or pain during intercourse) occurs in both women and men. It can often be attributed to local pathology and should then be properly categorised under the pathological condition. This category is to be used only if there is no primary nonorganic sexual dysfunction (e.g. Vaginismus or vaginal dryness).
Can be superficial or deep

41
Q

What are the physical causes of superficial dyspareunia?

A 
Vaginal atrophy
Infection eg HSV
Lichen sclerosis
Episiotomy/vaginal tear scar
Trauma
42
Q

What are the physical causes of deep dyspareunia?

A 
PID
Endometriosis
IBS
Fibroids/adenomyosis
PCOS
43
Q

What are the psychological causes of dyspareunia?

A

History of abuse
Painful/traumatic sexual experience/gynae examination
Poor sexual education and understanding of anatomy and physiology
Insufficient relaxation
Poor technique of partner eg timing and speed
Fear of intimacy
Anger / resentment towards partner

44
Q

How do you treat dyspareunia?

A 
Physical
Testosterone replacement
Steroid cream eg dermovate	
Topical oestrogen
Lubricants
Psychological
Psychosexual therapy
Behavioural eg sensate focus, personal sexual growth programme
Mindfulness
Kegels
45
Q

What is the mechanism of action for sildenafil?

A

PDE5 inhibitor - Vasodilator

46
Q

5 key principles of couple therapy

A 
Improve communication
Modify dysfunctional behaviour
Decrease emotional avoidance
Change view of relationships
Promote strengths
47
Q

Define sex assigned at birth

A

Sex decided upon by doctors and family according to external genitalia

48
Q

Define gender identity

A

Intrinsic sense of being male/female/other

49
Q

Define gender role/expression

A

Personality, appearance and behaviour

50
Q

Define dysphoria

A

Distress due to incongruence between gender identity and sex assigned at birth

51
Q

Define Transsexual

A

Individuals who seek to change or have changed their primary and secondary sexual characteristics to be in line with their gender identity

52
Q

Define sexual orientation

A

Sex of persons to whom sexual fantasies, arousal and activities are directed

53
Q

Limitations of the literature regarding gender dysphoria

A

Methodological issues
Funding issues and observer bias
Evangelism
Fallacy of neuro-genetic determinism

54
Q

Transition management (Transmale)

A 
Assessment and diagnosis
Social transition ± psychotherapy/OT
Fertility options
Androgens ± GnRH analogues
Voice and communication
Male chest reconstruction
Hysterectomy ± bilateral oophorectomy
Phalloplasty/metoidioplasty
55
Q

Transition management (Transfemale)

A 
Assessment and diagnosis
Social transition ± psychotherapy/OT
Fertility options
Oestrogens ± antiandrogens
Voice and communication
Facial hair removal
Vaginoplasty
Augmentation mammoplasty
Facial feminisation surgery
56
Q

How are children with gender dysphoria managed?

A

Psychotherapy prepuberty
GnRH analogues at puberty (tanner stage 2) until adults
Transfer to adult services at 18?
Adult treatment as above

Phase 3a (5 decks)

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