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3b specialties > Sexual medicine > Flashcards

Sexual medicine Flashcards

1
Q

What are the 4 main couple therapy approaches?

A
  • Cognitive behavioural
  • Psychodynamic
  • Systemic
  • Integrative
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2
Q

What does cognitive behavioural couples therapy focus on?

A

Dysfunctional patterns of belief and behaviour in the here-and-now.

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3
Q

What does psychodynamic couple therapy focus on?

A

Relationship between current probs and earlier patterns of response and behaviour from earlier life. Takes into account unconscious processes

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4
Q

What does systemic couple therapy focus on?

A

Process and context rather than content to bring about change which is not necessarily based on understanding and intent

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5
Q

What is integrative couple therapy?

A

Uses understanding and interventions from more than one approach.

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6
Q

Give 4 possible barriers to treatment for sexual dysfunction.

A
  • 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
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7
Q

2 options of where to refer someone with sex/relationship problems in Sheffield?

A

Porterbrook clinic, Relate, College of Sexual and Relationship therapists, Sex Addicts Anon., British Assoc for sexual and relationship therapy.

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8
Q

Define sex.

A

Sex is assigned at birth according to your genetic makeup. Someone is deemed M/F according to their external genitalia

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9
Q

Define gender identity.

A

The intrinsic sense of being M/F/alternative

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10
Q

Define gender role/expression.

A

A person’s personality, appearance and behaviour that are associated with gender in a cultural and historic context

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11
Q

What are the primary sexual characteristics in:

a) a girl
b) a boy?

A

a) vagina, vulva and ovaries

b) penis, scrotum and testes

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12
Q

Secondary sex characteristics in:

a) a girl
b) a boy?

A

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.

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13
Q

What chromosomal abnormality is present in Klinefelter syndrome?

A

47XXY

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14
Q

Give 3 possible features of Klinefelter syndrome.

A
  • Small/firm testes
  • Learning difficulties
  • Reduced libido
  • Gynaecomastia
  • Sparse facial hair
  • Infertility
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15
Q

How does congenital adrenal hyperplasia affect sex characteristics?

A

Excess of androgens (testosterone) which causes precocious puberty in boys or virilisation in girls.

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16
Q

Define transgender.

A

Someone who identifies and lives as a different gender to the sex they were assigned at birth

17
Q

Define gender dysphoria

A

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

18
Q

Define transexual

A

Individuals who seek to change/have changed their primary and/or secondary sex characteristics

19
Q

Define sexual orientation.

A

The sex of person/s to whom sexual fantasies, arousal and activities are directed

20
Q

In embryology, around when do the external genitalia and gonads develop?

A

~ week 8

21
Q

What determines defeminisation/masculinisation in embrology.

A

Y chromosome has SRY gene which produces testis-determining factor protein.

22
Q

What 2 factors secreted by the testes in embrology contribute to sex determination and how?

A
  • Testosterone –> retains the mesonephric duct

- Mullerian inhibiting substance –> regression of paramesonephric duct

23
Q

What do these structures develop into:

a) mesonephric ducts
b) paramesonephric ducts?

A

a) epididymis duct, ductus deferens, ejaculatory duct, seminal vesicle
b) fallopian tubes, uterus, cervix, upper 2/3rd vagina

24
Q

When does sexual differentiation of the brain occur, and what contributes to gender identity?

A

2nd half of pregnancy

Testosterone, oestrogen, genese

25
Q

What did Reiner (2005) and Zucker and Lawrence (2009) find the influence of sex-of-rearing was on gender identity?

A

Lack of influence of sex-of-rearing environment

26
Q

Van der Miesen et al/ (2016) found an association between gender dysphoria and what?

A

ASD

27
Q

According to Ramachandran and McGeoh, what % experience phantom penis after penectomy:

a) of men
b) after male to female transition?

A

a) 60%

b) 30%

28
Q

What % of FtM report phantom penis before gender reassignmenet?

A

60%

29
Q

Is there a genetic component to being transgender?

A

Yes, there’s a higher concordance of transgender/gender dysphoria in twin and first degree relatives.
(Veale et al 2010, Hare et al 2009)

30
Q

What did Swaab and Garcia Falgueras (2009) find about gender atypical behaviour?

A

More a predictor of adult homosexuality/bisexuality rather than trans-sexuality.

31
Q

Give 3 things that NHS England says trans people are vulnerable to?

A
  • 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
32
Q

What is the attempted suicide rate in transgender people vs the general population?

A

41% vs 16%

33
Q

What is the DSM-V definition of gender dysphoria?

Give 3 ways it may manifest.

A

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
34
Q

Outline the management options for transmales, following assessment and diagnosis.

A
  • Social transition +/- psychotherapy/OT
  • Fertility options
  • Androgens +/- GnRH analogue
  • Voice and communication
  • Male chest reconstruction
  • hysterectomy + b/l salpingoopherectomy
  • phalloplasty/metoidoplasty
35
Q

Outline management options for transfemales, following assessment and diagnosis.

A
  • Social transition +/- psychotherapy/OT
  • Fertility options
  • Oestrogens +/- antiandrogens
  • Voice and communication
  • Facial hair removal
  • Vaginoplasty
  • Augmentation mammoplasty
  • Facial feminisation surgery
36
Q

Give 3 physiological causes of rapid ejaculation.

A

Genetic susceptibility, penile hypersensitivity, hyperthyroid, prostatitis, co-morbid sexual problems (ED), medication (sympathomimetic)

37
Q

Give 3 psychological causes of rapid ejaculation.

A

Anxiety, early learned experiences, lack of experience, infrequent sexual activity, environmental factors, relationship issues, partner issues e.g. pain

3b specialties (15 decks)

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