Sexual medicine - Worst lecture of all time Flashcards
1
Q
Components of a sexual history
A
5Ws Onset Precipitants Describe last successful experience Is the problem always present Previous attempted remedies
2
Q
Additional components of a sexual history
A
Relationship quality Personal, social and family history Psychiatric history Medical history Alcohol, nicotine, steroid and drug use Reproductive histories
3
Q
When is physical examination required
A
Pain disorders
Co-morbidities
Prescribing topical agents
4
Q
Blood tests
A
Fasting glucose - Diabetes Lipids - CVD Testosterone Sex hormone binding globulin Albumin Prolactin TSH Oestrogen FBC
5
Q
What is male hypoactive sexual desire disorder
A
Lack or loss of sexual desire Persistently deficient (or absent) sexual thoughts and desire for sexual activity
6
Q
Chronic conditions associated with HSDD
A
Obesity
CVD
DM
Anaemia
7
Q
Hormonal disorders associated with MALE HSDD
A
Angroden deficiency
Hypogonadism
Hyperprolactinaemia
8
Q
Hormonal disorders associated with FEMALE HSDD
A
Androgen deficiency Hypothyroidism Hyperprolactinaemia Post-pregnancy Addison's
9
Q
Iatrogenic causes of MALE HSDD
A
Anti-depressants Anti-psychotics B-blockers Finasteride Orchidectomy
10
Q
Iatrogenic causes of FEMALE HSDD
A
Anti-depressants Anti-psychotics B-blockers OCP HRT Tamoxifen Oophorectomy
11
Q
Psychological causes of HSDD
A
Depression Anxiety Substance abuse Life trauma Body image disorder Erotic dissatisfaction Relationship problems
12
Q
Psychosexual treatments
A
Integrative - Psychosexual + physical Cognitive Behavioural CBT Psychodynamic Systemic
13
Q
HSDD treatment
A
Testosterone replacement
Individual psychosexual therapy
Behavioural intervention - Sexual growth programme
14
Q
What is erectile dysfunction
A
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
15
Q
Physiological causes of ED
A
CVD DM Neurological disease Androgen deficiency High prolactin Increasing age Ineffective stimuli Pain Veno-occlusive disorder
16
Q
Iatrogenic causes of ED
A
Post-prostate surgery
B-blockers
SSRIs
17
Q
Psychological causes of ED
A
Depression Substance abuse Performance anxiety Life trauma Negative experiences Relationship problems Relationship trauma
18
Q
ED treatment - Medical
A
Sildenafil
Tadalafil
Intra-cavernosal - Alprostadil
Intraurethral
- Alprostadil pellet
- Alprostadil cream
19
Q
Viagra advice
A
Require sexual stimulation
Work best on an empty stomach
45-60 minutes
Efficacy improves with each dose
20
Q
ED treatment - NON-medical
A
Vacuum device Penile/scrotal rings Enhancing lubricants Vibrators Kegel exercises
21
Q
Female sexual arousal disorder
A
Lack of sexual arousal, as manifested by absent or reduced…
- Interest in sexual activity
- Sexual thoughts
- Initiation of sexual activity
- Sexual pleasure
- Arousal in response to erotic stimuli
- Genital or non-genital sensations during sexual activity
22
Q
Physiological causes of female sexual arousal disorder
A
CVD DM Neurological disease Connective tissue disease Oestrogen deficiency Breastfeeding
23
Q
Iatrogenic causes of female sexual arousal disorder
A
Anti-depressants
24
Q
Psychological causes of female sexual arousal disorder
A
Depression Anxiety Eating disorders Previous abuse Decreased intimacy Relationship problems
25
Female orgasmic disorder
Delay
Infrequency
Absence
Reduced intensity
26
Physiological causes of female orgasmic disorder
```
CVD
DM
Neurological disease
Renal/liver problems
Oestrogen deficiency
Androgen insufficiency
Hypothyroidism
Pelvic floor weakness
Increasing age
```
27
Iatrogenic causes of female orgasmic disorder
SSRIs
28
Psychiatric causes of female orgasmic disorder
```
Depression
Anxiety
Substance abuse
Previous abuse
Relationship problems
Environmental factors
Stress
```
29
Female orgasmic disorder treatment
Treat cause
| Psychotherapy
30
How can menopause affect sexual function
```
Vaginal or pelvic pain
Vaginal atrophy
Dryness
Change in self image
Mood changes
Memory problems
Lack of desire
Physical discomfort
```
31
Premature ejaculation
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
< 1 minute
32
Physiological causes of premature ejaculation
```
Genetic susceptibility
Penile hypersensitivity
Hyperthyroidism
Prostatitis
Co-morbidities
Sympathomimetic medication
```
33
Psychological causes of premature ejaculation
```
Anxiety
Early learned experiences
Lack of experience
Environmental factors
Relationship issues
Partner issues
```
34
Premature ejaculation treatments
Topical local anaesthetics - Stud 100 spray
DAPOXETINE
Psychosexual therapy
Behavioural interventions
35
Delayed ejaculation
Delay
Infrequency
Absence
Without the desire of delay
36
Physiological causes of delayed ejaculation
```
Congenital disorders
Trauma/surgery
Age
Infectious disease
Neurological disease
Low testosterone
EXCLUDE RETROGRADE EJACULATION
```
37
Psychological causes delayed ejaculation
```
Depression
Inefficient stimulation/arousal
Poor technique
Body image disorders
Previous abuse
Relationship problems
```
38
Iatrogenic causes of delayed ejaculation
SSRIs
Phenothiazines
Thiazides
A-blockers
39
Delayed ejaculation investigations
```
Physical examination
FBC
Glucose
Testosterone
B12
Folate
PSA
SPERM IN URINE INDICATES RETROGRADE EJACULATION
```
40
Vaginismus
Spasm of pelvic floor muscles surrounding vagina
Occlusion of vaginal opening
Penile entry impossible or painful
41
Physiological causes of vaginismus
Thrush
Pain conditions
FGM
Congenital abnormality
42
Psychological causes of vaginismus
```
First intercourse - Fear of pain
Fear of pregnancy
Previous abuse
Fear of partner
Relationship dissatisfaction
Situational
```
43
Vaginismus treatments
```
Psychosexual therapy
CBT
Behavioural interventions
Relaxation techniques
VAGINAL TRAINERS
Kegel exercises
```
44
Dyspareunia
Pain during intercourse
45
Physiological causes of manipulation dyspareunia
```
Infection
Injury
Irritation
Lesions
Hypersensitivity
```
46
Physiological causes of introitus dyspareunia
```
Episiotomy
Recurrent infection
Herpes
Bartholin's cyst
Cystitis
Urethritis
Vaginal atrophy
Poor lubrication
```
47
Physiological causes of deep dyspareunia
```
Endometriosis
Shortened vagina
Fixed uterine retroversion
Pelvic tumour
Surgical adhesions
IBS
Constipation
```
48
Psychological causes of dyspareunia
```
Previous painful experience
Previous abuse
Poor education
Poor understanding of anatomy
Insufficient relaxation
Relationship problems
```
49
Dyspareunia treatments
Treat underlying cause
Steroid creams - Dermovate
Couples therapy
Sexual growth programme
50
Main relationship issues
```
Communication
Timetabling
Conflict
Difficulty compromising
Power issues
Trust issues
Sexual problems
```
51
How does chronic illness impact relationships
```
Withdrawal
Tiredness
Low mood
Anxiety
Body image disorders
Role changes
Limits on mobility
Mental disturbance
```
52
Principles of couples therapy
```
Create a working alliance
Offer insight and understanding
Manage feelings
Effective communication
Change dysfunctional thought patterns
Resolve conflict
Compromise
Shift dynamics
```
53
CBT for couples
Focus on dysfunctional patterns of belief and behaviour
54
Psychodynamic couples therapy
Focuses on current problems and earlier patterns of response from earlier life
Considers unconscious processes
55
Systemic couples therapy
Focuses on process and context
56
Integrative couples therapy
Understanding and interventions from multiple approaches
