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3A > Sexual medicine - Worst lecture of all time > Flashcards

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
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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
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3
Q

When is physical examination required

A

Pain disorders
Co-morbidities
Prescribing topical agents

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4
Q

Blood tests

A 
Fasting glucose - Diabetes 
Lipids - CVD 
Testosterone 
Sex hormone binding globulin
Albumin 
Prolactin 
TSH 
Oestrogen 
FBC
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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
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6
Q

Chronic conditions associated with HSDD

A

Obesity
CVD
DM
Anaemia

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7
Q

Hormonal disorders associated with MALE HSDD

A

Angroden deficiency
Hypogonadism
Hyperprolactinaemia

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8
Q

Hormonal disorders associated with FEMALE HSDD

A 
Androgen deficiency 
Hypothyroidism 
Hyperprolactinaemia 
Post-pregnancy 
Addison's
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9
Q

Iatrogenic causes of MALE HSDD

A 
Anti-depressants 
Anti-psychotics
B-blockers 
Finasteride 
Orchidectomy
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10
Q

Iatrogenic causes of FEMALE HSDD

A 
Anti-depressants 
Anti-psychotics 
B-blockers
OCP
HRT 
Tamoxifen 
Oophorectomy
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11
Q

Psychological causes of HSDD

A 
Depression
Anxiety 
Substance abuse 
Life trauma 
Body image disorder
Erotic dissatisfaction
Relationship problems
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12
Q

Psychosexual treatments

A 
Integrative - Psychosexual + physical 
Cognitive
Behavioural 
CBT 
Psychodynamic 
Systemic
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13
Q

HSDD treatment

A

Testosterone replacement
Individual psychosexual therapy
Behavioural intervention - Sexual growth programme

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14
Q

What is erectile dysfunction

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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15
Q

Physiological causes of ED

A 
CVD 
DM 
Neurological disease
Androgen deficiency 
High prolactin 
Increasing age 
Ineffective stimuli 
Pain 
Veno-occlusive disorder
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16
Q

Iatrogenic causes of ED

A

Post-prostate surgery
B-blockers
SSRIs

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17
Q

Psychological causes of ED

A 
Depression 
Substance abuse 
Performance anxiety 
Life trauma 
Negative experiences 
Relationship problems
Relationship trauma
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18
Q

ED treatment - Medical

A

Sildenafil
Tadalafil

Intra-cavernosal - Alprostadil

Intraurethral

  • Alprostadil pellet
  • Alprostadil cream
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19
Q

Viagra advice

A

Require sexual stimulation
Work best on an empty stomach
45-60 minutes
Efficacy improves with each dose

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20
Q

ED treatment - NON-medical

A 
Vacuum device
Penile/scrotal rings 
Enhancing lubricants 
Vibrators 
Kegel exercises
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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
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22
Q

Physiological causes of female sexual arousal disorder

A 
CVD 
DM 
Neurological disease
Connective tissue disease
Oestrogen deficiency 
Breastfeeding
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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
Q

Female orgasmic disorder

A

Delay
Infrequency
Absence
Reduced intensity

26
Q

Physiological causes of female orgasmic disorder

A 
CVD 
DM
Neurological disease
Renal/liver problems
Oestrogen deficiency 
Androgen insufficiency
Hypothyroidism 
Pelvic floor weakness 
Increasing age
27
Q

Iatrogenic causes of female orgasmic disorder

A

SSRIs

28
Q

Psychiatric causes of female orgasmic disorder

A 
Depression
Anxiety 
Substance abuse 
Previous abuse 
Relationship problems 
Environmental factors 
Stress
29
Q

Female orgasmic disorder treatment

A

Treat cause

Psychotherapy

30
Q

How can menopause affect sexual function

A 
Vaginal or pelvic pain
Vaginal atrophy
Dryness 
Change in self image
Mood changes 
Memory problems
Lack of desire 
Physical discomfort
31
Q

Premature ejaculation

A

Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
< 1 minute

32
Q

Physiological causes of premature ejaculation

A 
Genetic susceptibility 
Penile hypersensitivity 
Hyperthyroidism 
Prostatitis 
Co-morbidities 
Sympathomimetic medication
33
Q

Psychological causes of premature ejaculation

A 
Anxiety 
Early learned experiences 
Lack of experience 
Environmental factors 
Relationship issues 
Partner issues
34
Q

Premature ejaculation treatments

A

Topical local anaesthetics - Stud 100 spray
DAPOXETINE
Psychosexual therapy
Behavioural interventions

35
Q

Delayed ejaculation

A

Delay
Infrequency
Absence
Without the desire of delay

36
Q

Physiological causes of delayed ejaculation

A 
Congenital disorders 
Trauma/surgery 
Age 
Infectious disease 
Neurological disease
Low testosterone 
EXCLUDE RETROGRADE EJACULATION
37
Q

Psychological causes delayed ejaculation

A 
Depression 
Inefficient stimulation/arousal 
Poor technique 
Body image disorders
Previous abuse 
Relationship problems
38
Q

Iatrogenic causes of delayed ejaculation

A

SSRIs
Phenothiazines
Thiazides
A-blockers

39
Q

Delayed ejaculation investigations

A 
Physical examination
FBC 
Glucose 
Testosterone 
B12 
Folate 
PSA 
SPERM IN URINE INDICATES RETROGRADE EJACULATION
40
Q

Vaginismus

A

Spasm of pelvic floor muscles surrounding vagina
Occlusion of vaginal opening
Penile entry impossible or painful

41
Q

Physiological causes of vaginismus

A

Thrush
Pain conditions
FGM
Congenital abnormality

42
Q

Psychological causes of vaginismus

A 
First intercourse - Fear of pain 
Fear of pregnancy 
Previous abuse 
Fear of partner 
Relationship dissatisfaction 
Situational
43
Q

Vaginismus treatments

A 
Psychosexual therapy 
CBT 
Behavioural interventions 
Relaxation techniques 
VAGINAL TRAINERS
Kegel exercises
44
Q

Dyspareunia

A

Pain during intercourse

45
Q

Physiological causes of manipulation dyspareunia

A 
Infection 
Injury 
Irritation 
Lesions 
Hypersensitivity
46
Q

Physiological causes of introitus dyspareunia

A 
Episiotomy 
Recurrent infection
Herpes 
Bartholin's cyst 
Cystitis 
Urethritis 
Vaginal atrophy 
Poor lubrication
47
Q

Physiological causes of deep dyspareunia

A 
Endometriosis 
Shortened vagina 
Fixed uterine retroversion
Pelvic tumour 
Surgical adhesions 
IBS 
Constipation
48
Q

Psychological causes of dyspareunia

A 
Previous painful experience 
Previous abuse 
Poor education 
Poor understanding of anatomy 
Insufficient relaxation
Relationship problems
49
Q

Dyspareunia treatments

A

Treat underlying cause
Steroid creams - Dermovate
Couples therapy
Sexual growth programme

50
Q

Main relationship issues

A 
Communication 
Timetabling 
Conflict 
Difficulty compromising
Power issues  
Trust issues 
Sexual problems
51
Q

How does chronic illness impact relationships

A 
Withdrawal 
Tiredness 
Low mood 
Anxiety 
Body image disorders 
Role changes 
Limits on mobility 
Mental disturbance
52
Q

Principles of couples therapy

A 
Create a working alliance 
Offer insight and understanding 
Manage feelings 
Effective communication
Change dysfunctional thought patterns 
Resolve conflict 
Compromise 
Shift dynamics
53
Q

CBT for couples

A

Focus on dysfunctional patterns of belief and behaviour

54
Q

Psychodynamic couples therapy

A

Focuses on current problems and earlier patterns of response from earlier life
Considers unconscious processes

55
Q

Systemic couples therapy

A

Focuses on process and context

56
Q

Integrative couples therapy

A

Understanding and interventions from multiple approaches

3A (31 decks)

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