Sexual medicine Flashcards
Rapid ejaculation
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Premature ejaculation
Ejaculation < 1 minute after penetration
Before the person wishes it
Rapid ejaculation aetiology
Physiological
- Genetic - Neuroreceptor sensitivity
- Penile hypersensitivity
- HYPERTHYROIDISM
- Prostatitis
- Co-morbid sexual problems - ED?
- Sympathomimetic medication
Psychological
- Anxiety
- Early learned experiences
- Lack of experience
- Relationship issues
- Partner issues
Rapid ejaculation management
Pharmacological
Topical local anaesthetic - Stud 100 spray
SSRI - Dapoxetine
Rapid ejaculation management
Non-pharmacological
Couples psychosexual therapy
- Education
- Permission giving
- Normalising
- Managing partner expectations
Behavioural interventions
- Stop/start technique
- Sensate focus
- Practicing the point of inevitability
- Kegel exercises
Vaginismus
Spasm of pelvic floor muscles surrounding the vagina
Occlusion of the vaginal opening
Penile entry impossible or painful
Vaginismus aetiology
Physiological
- Medical conditions where the vulva is sore - Thrush?
- Other conditions where pain is anticipated
- FGM
- Congenital abnormality
Psychological
- Misinformation and mistaken beliefs
- Religious or cultural issues
- Fear of pregnancy
- Previous sexual abuse
- Unpleasant first experience
- Relationship issues - Fear or dislike of partner
Vaginismus management
Individual psychosexual therapy
- Explore family origin
- Childhood and social history
- Relationships and sexual history
- Cultural beliefs
- Sexual abuse?
Integrated CBT - Deconstruct and control phobic reaction
Behavioural interventions
- Breathing control and relaxation
- Self-exploration with a mirror
- Personal sexual growth programme
VAGINAL TRAINERS
Sexual medicine
Formulating an assessment
BIOPSYCHOSOCIAL
Predisposing factors
Precipitating factors
Maintaining factors
Sexual medicine
Management options
CBT - Address unhelpful thinking
- Sensate focus
- Personal sexual growth programme
Psychodynamic - Past events and unconscious motivations
Integrated - Psychosexual and physical treatments
Systemic - Individual, couple and family dynamics
