Sexual Medicine Peer Teaching Flashcards
What is female sexual interest/ arousal disorder
Reduced or absent sexual interest, physical responses to sexual stimuli, erotic thoughts, sexual pleasure
What is female orgasmic disorder
Absent, infrequent, reduced or delayed orgasm
What is genitopelvic pain/ penetration disorder
Fear/anxiety, tightening, vulvovaginal pain with attempted vaginal penetration during or after seex
What is the normal female physical response to sexual stimuli
Pelvic vasocongestion, swelling of external genitalia, vaginal lubrication and expansion
Biological causes of female sexual dysfunction
Age Menopause Thyroid, DM, pituitary adenoma Atherosclerosis Neuro Meds
Why can menopause cause sexual dysfunction
Low oestrogen causes urogenital atrophy, thin, dry skin, pain
Which class of drugs in particular cause female sexual dysfunction?
SSRI
Psychological causes of female sexual dysfunction
Previous abuse
Body image
Depression/ anxiety
Social causes of female sexual dysfunction
Relationship troubles
Life stresses
Pressure to perform
Causes of superficial dyspareunia
Vaginismus, insufficient lube, thrush, herpes, vestibulo/vulvodynia
Causes of deep dyspareunia
Insufficient lube, pelvic inflammatory disease, endometriosis, cervical pathology
Investigation of female sexual dysfunction
History
Exam
Blood pressure
Bloods
Which bloods would you do for female sexual dysfunction
TFT, Prolactin, testosterone, oestrogen, SHBG (sex hormone binding globulin), glucose, lipids, FBC
Treatment for female sexual dysfunction
Pyschotherapy
Treat underlying physical cause
Kegel exercises
Topical oestrogen
Causes of erectile dysunction
Atherosclerosis Neuro DM High prolactin Pscyhological Agnrodgen deficiency Venoclusive disease
Causes of androgen deficiency
Lack of testosterone Age, obesity Chemo, radio, mumps affect testicular function Pituitary adenoma or prolactinoma Hypothalamus Absent gonads
Bloods for ED
TFT, Prolactin, testosterone, SHBG (sex hormone binding globulin), glucose, lipids, FBC
Why are atherosclerosis and ED an important connection
Will present clinically earlier as smaller artery so smaller plaque has bigger effect on flow
ED treatments
Sildenafil Intracorporeal injection of alprostadil Vacuum device Kegels Penile ring
What type of drug is sildenafil
PDE5 inhibitor (phosphodiesterase)
What type of drug is alprostadil
Prostaglandin E1 (PGE1)
Definition of premature ejaculation
Inability to control ejaculation, usually under 60s. Requires minimal stimulation, inadequate for both partners to enjoy sex
Causes of premature ejaculation
Penile hypersensitivity
Hyperthyroid
Psycho- anxiety, lack of experience, relationship troubles
Premature ejaculation treatment
Desensitising gel
Couples therapy
Kegels
Stop start continue
Name 4 psychosexual couples therapy approaches
CBT
Psychodynamic
Stystemic
Inegrative
Describe CBT approach to couples therapy
Cognitive= reduces unhelpful thinking Behavioural= touch exercises with partner, personal sexual growth programme
Describe psychodynamic approach to couples therapy
Explore unresolved issues, previous dysfunctional relationships
Describe systemic approach to couples therapy
Interactions/ roles in a relationship
Describe the integrative approach to couples therapy
Mixed approach
What must a sexual disorder be to be classed as a disorder
Persistent
Cause marked distress
Hypoactive sexual disease disorder
Lack or loss of sexual desire causing distress (doesnt preclude sexual enjoyment or arousal but makes the initiation of sex less likely)
How is testosterone replacement given
Repeat tests, injections, transdermal patches, buccal, subcut implants
Premenopausal and hypoactive sexual desire disorder treatment in women
Flibanserin
Side effects of sildenafil
Head aches and flushing
Contraindications of sildenafil
Hypertension
Female orgasmic disorder treatment
Topical oestrogens
Behavioural interventions: guided masturbation and vibrators
Define vaginismus
Spasm of the pelvic floor muscles that surround the vaginal opening, make penile entry painful or impossible
Causes of vaginismus
Thrush, FGM, Congenital abnormality. Previous trauma/abuse, fear/dislike of partner or pregnancy, misinformed
Treatment of vaginismus
Self exploration, vaginal dilators, graded penetration therapy
Describe candida albicans
Cottage cheese.
Immunosuppresion causes it. Diagnosis: MC+S shows mycelia spores
Antifungals: Clotrimazole, fluconazole
Describe bacterial vaginosis
White fishy smelly
Sexually active, IUCD, new partner
Ix: pH>4.5, CLUE CELLS.
Tx: Metronidazole
Describe gonnorhea
Neisseria gonorrhoea
Previous STI, multiple partners.
NAAT
IM Ceftriaxzone (+Aziothromycin for chlamydia), contract tracing
Descirbe Neisseria Gonorrhoea
Gram negative diplococcus
What is NAAT
Nucleic acid amplification test
What symptoms can you get for gonorrhoea
Normally none but can get discharge and dysuria
What symptoms can you get for chlamydia
Usually none but can get discharge, dysuria and IMB
Describe chlamydia
Chlamydia Trachomatis Previous STI, multiple partners. NAAT, swabs PID/ Reiters Aziothromycin Contact tracing
Describe chlamydia trachomatis
Gram negative cocci
What is Reiters syndrome
Cant see, cant wee, cant climb a tree
Conjuctivitis, urethritis, reactive arthritis
What is PID most commonly caused by
Chlamydia
Describe trichmonas vaginalis
T. Vaginalis Frothy offensive yellow/green discharge, strawberry cervic, dysuria, itchy and sore NAAT, swabs Metronidazole Treat partner too
Describe trichomonas vaginalis histologically
Flagellated protozoan
Cause of genital warts and consequence
HPV 6 and 11, both external so dont have cervical cancer risk
Describe genital warts
Growths/lesions, multiple or solitary, painless, itch, dyspareunia
Diagnosis of genital warts
Examination and STI screen
Treatment of genital warts
Cryotherapy and podophyllotoxin cream
