Sexual medicine Flashcards
What are the 4 main couple therapy approaches?
- Cognitive behavioural
- Psychodynamic
- Systemic
- Integrative
What does cognitive behavioural couples therapy focus on?
Dysfunctional patterns of belief and behaviour in the here-and-now.
What does psychodynamic couple therapy focus on?
Relationship between current probs and earlier patterns of response and behaviour from earlier life. Takes into account unconscious processes
What does systemic couple therapy focus on?
Process and context rather than content to bring about change which is not necessarily based on understanding and intent
What is integrative couple therapy?
Uses understanding and interventions from more than one approach.
Give 4 possible barriers to treatment for sexual dysfunction.
- Lack of partner involvement
- What medical support is available
- Inadequate follow up
- Both patient and partner education is needed
- Lack of acceptance of psychological treatment
- Time pressures
- Anxiety levels
- Cultural and religious considerations
2 options of where to refer someone with sex/relationship problems in Sheffield?
Porterbrook clinic, Relate, College of Sexual and Relationship therapists, Sex Addicts Anon., British Assoc for sexual and relationship therapy.
Define sex.
Sex is assigned at birth according to your genetic makeup. Someone is deemed M/F according to their external genitalia
Define gender identity.
The intrinsic sense of being M/F/alternative
Define gender role/expression.
A person’s personality, appearance and behaviour that are associated with gender in a cultural and historic context
What are the primary sexual characteristics in:
a) a girl
b) a boy?
a) vagina, vulva and ovaries
b) penis, scrotum and testes
Secondary sex characteristics in:
a) a girl
b) a boy?
a) Enlargement of genitalia, development of breasts, pubic and armpit hair, menarche
b) enlargement of genitalia, lowering of voice, redistribution of muscle and fat, pubic/facial/body/armpit hair.
What chromosomal abnormality is present in Klinefelter syndrome?
47XXY
Give 3 possible features of Klinefelter syndrome.
- Small/firm testes
- Learning difficulties
- Reduced libido
- Gynaecomastia
- Sparse facial hair
- Infertility
How does congenital adrenal hyperplasia affect sex characteristics?
Excess of androgens (testosterone) which causes precocious puberty in boys or virilisation in girls.
Define transgender.
Someone who identifies and lives as a different gender to the sex they were assigned at birth
Define gender dysphoria
Distress due to incongruence between gender identity and sex assigned at birth
Define transexual
Individuals who seek to change/have changed their primary and/or secondary sex characteristics
Define sexual orientation.
The sex of person/s to whom sexual fantasies, arousal and activities are directed
In embryology, around when do the external genitalia and gonads develop?
~ week 8
What determines defeminisation/masculinisation in embrology.
Y chromosome has SRY gene which produces testis-determining factor protein.
What 2 factors secreted by the testes in embrology contribute to sex determination and how?
- Testosterone –> retains the mesonephric duct
- Mullerian inhibiting substance –> regression of paramesonephric duct
What do these structures develop into:
a) mesonephric ducts
b) paramesonephric ducts?
a) epididymis duct, ductus deferens, ejaculatory duct, seminal vesicle
b) fallopian tubes, uterus, cervix, upper 2/3rd vagina
When does sexual differentiation of the brain occur, and what contributes to gender identity?
2nd half of pregnancy
Testosterone, oestrogen, genese
What did Reiner (2005) and Zucker and Lawrence (2009) find the influence of sex-of-rearing was on gender identity?
Lack of influence of sex-of-rearing environment
Van der Miesen et al/ (2016) found an association between gender dysphoria and what?
ASD
According to Ramachandran and McGeoh, what % experience phantom penis after penectomy:
a) of men
b) after male to female transition?
a) 60%
b) 30%
What % of FtM report phantom penis before gender reassignmenet?
60%
Is there a genetic component to being transgender?
Yes, there’s a higher concordance of transgender/gender dysphoria in twin and first degree relatives.
(Veale et al 2010, Hare et al 2009)
What did Swaab and Garcia Falgueras (2009) find about gender atypical behaviour?
More a predictor of adult homosexuality/bisexuality rather than trans-sexuality.
Give 3 things that NHS England says trans people are vulnerable to?
- Lack of family and social support and acceptance
- Discrimination at work
- Lack of access to services
- Increased risk of anxiety/depresson/substance misuse/self harm
What is the attempted suicide rate in transgender people vs the general population?
41% vs 16%
What is the DSM-V definition of gender dysphoria?
Give 3 ways it may manifest.
Marked incongruence between one’s experienced/expressed gender, and assigned gender, for at least 6 months. Manifested by at least 2 of:
- Incongruence between one’s gender and primary/secondary sex characteristics
- Strong desire to be rid of sex characteristics due to incongruence
- Strong desire for sex characteristics of other gender
- Strong desire to be of the other gender/treated as
- Conviction one has typical feelings/reactions of other gender
Outline the management options for transmales, following assessment and diagnosis.
- Social transition +/- psychotherapy/OT
- Fertility options
- Androgens +/- GnRH analogue
- Voice and communication
- Male chest reconstruction
- hysterectomy + b/l salpingoopherectomy
- phalloplasty/metoidoplasty
Outline management options for transfemales, following assessment and diagnosis.
- Social transition +/- psychotherapy/OT
- Fertility options
- Oestrogens +/- antiandrogens
- Voice and communication
- Facial hair removal
- Vaginoplasty
- Augmentation mammoplasty
- Facial feminisation surgery
Give 3 physiological causes of rapid ejaculation.
Genetic susceptibility, penile hypersensitivity, hyperthyroid, prostatitis, co-morbid sexual problems (ED), medication (sympathomimetic)
Give 3 psychological causes of rapid ejaculation.
Anxiety, early learned experiences, lack of experience, infrequent sexual activity, environmental factors, relationship issues, partner issues e.g. pain
