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