Sexual Problems Flashcards
Definition of a psychosexual problem
‘When thoughts, feelings or physiological response affects a person’s ability to enjoy sexual activity alone or with a partner’
Causes of psychosexual problems
Individual–> thoughts, feelings, physiology
Relational–> fear of informing partner, partner infidelity, blame or conflict
Societal–> actual or perceived stigma, isolation
Common Male sexual problem
Premature ejaculation
Erectile problems
Loss of sexual desire
Retarded ejaculation
Common Female sexual problem
Loss of sexual desire
Dyspareunia
Vaginismus
Orgasmic dysfunction
Types of sexual practices and disorders which can influence psychosexual health
Gender dysphoria
Paraphilic Disorders–> Voyeuristic/exhibitionist, Frotteuristic, Masochism/sadism, pedophilia, fetishistic disorders, tranvestic disorders
Incidence of psychosexual disorders
Men–>PE 3%, LSD 2%, ED 1%
Women–>LSD 10%, Orgasmic problems 4%, Dyspareunia 3%
Where do people seek help for psychosexual problems
Men –> GP 65%, GUM 10%, other 25%
Women–> GP 75%, GUM 5%, other 20%
When assessing a psychosexual problem
Problem itself:When did it start? all situations?
Psychogenic factors:How do you feel? Partner response? Any related problems (arousal, libido, pain,orgasm)?
Any significant physical PMHx?
Premature Ejaculation
Intravaginal ejaculatory latency time (IELT) of less than 1 minute
Can be lifelong or secondary
Causes of lifelong PE
psychogenic–> lack of learned control (most common), lack of sensory awareness
Organic –> inherited, 5HT receptor dysfunction
Causes of secondary PE
Psychogenic–> Anxiety/stress. Relational–> pressure, anger. Social–> pressure of perceived norms. Organic–>Prostatitis/BPH, hyperthyroid, neurological problems, medication (antidepressants, antihypertensives)
Management of PE
Information–> very common problem, 90% of men have IELT of 3. Masturbation with focusing
Pelvic floor exercises. Self help books are available
Medication (Antidepressants,PDE5 inhibitors or LA)
Assessing Erectile dysfunction (ED)
Strength of Erections–> 0-10, spontaneous/ masturbation/SI, is it the same with all partners?
Psychogenic–> >50yo, gradual onset,in all situations, PMHx and relevant medications
Treatments for ED
Physical check up–> BP, BMI/abdo girth, genitals, bloods, hormone levels
Medication–> Oral PDE inhibitors, trans-urethral or Intra-cavernosal prostaglandins,
Vacuum pumps or constriction ring
surgery or lifestyle changes
Oral PDE Inhibitors for ED
Sildenafil (viagra), Tadalafil (cialis) & Vardenafil (levitra) –> require arousal
60-90% effective compared to 20-50% placebo
Can cause headaches, flushing and reflux
Should not be used with nitrates or after a MI
onset 30-60mins and last for 12-48 hours
Intra-cavernosal prostaglandins
Alprostadil (Caverject or Viridal) work by peripheral S muscle relaxation
>75% efficacy compared to <10% placebo
can cause pain (17%), fibrosis (2%), priapism (1%) or haematoma (1.5%)
Dose titrated to response and onset in 5-10mins
Contra-indications for intra-cavernosal prostaglandins
Sickle cell, multiple myeloma, leukaemia, anatomical deformities.
Prescribing guidelines for ED
First line is to improve lifestyle and general health
Then try a PDE5 inhibitor
Can only get NHS treatment if there is a significant medical or surgical background or ‘severe distress’
Female Sexual Dysfunction
A general term encompassing:
–>Desire disorder
–>Arousal disorder (subject arousal vs genital arousal disorders)
–>Orgasmic disorder
Less often related to physiology and more linked to relationship quality
Medical Factors in the Aetiology of FSD
Endocrine–> hypothyroid, hyperprolactinaemia, oestrogen/testosterone deficiency
Neurological–>IDDM, MS
Vascular–>IHD, HTN
Psychiatric–>psychosis or depression
Systemic–> HIV, renal failure
Medication–> anticonvulsants, opiates, lithium, antipsychotics,benzos, antidepressants
Management of FSD
Rule out organic causes
Distinguish between subjective and genital arousal disorders–> for genital arousal disorder HRT, lubrication, PDE5 and increased stimulation
For desire, orgasmic and subjective arousal disorders–> refer for psychosexual help
Dyspreunia
A persistent or recurrent genital pain associated with sexual intercourse–> can be superficial or deep
Many organic causes–> need to pinpoint the source of pain, inadequate arousal is the major cause
Causes of Superficial Dyspareunia
Structural–>stricture of hymen or vagina, vulval cancer
Endocrine–>diabetic, menopausal atrophy
Infection–>thrush, trichomonas, herpes
Inflammatory–>lichen sclerosus, allergies, ezcema
Surgical–> post-episiotomy, FGM, anterior/posterior repairs
Causes of deep dyspareunia
Structural –>stricture of vagina or fibroids
Infection–> PID
Inflammatory–>endometriosis or IBD
Neoplastic–> cancer of cervix, uterus or ovary
Surgical–> post-hysterectomy
Vaginismus
Persistant or recurrent difficulty in allowing desired vaginal entry by any object. often associated with phobic avoidance. Involves involuntary pelvic muscle contraction and anticipation/fear/experience of pain
–> Leads to superficial dyspareunia or non-consumation
Causes of Vaginismus
Psychological–> fear of pain/pregnancy/adulthood, guilt or past bad experiences
Relationship–> masking partner dysfunction
Social/cultural–> FGM
Medical–> Anything which can cause dyspareunia can cause protective vaginismic reflexes
Management of Vaginismus
Stop the pain–> break the cycle
Pelvic floor exercises–> control the spasm
Self-exploration–> desensitizes the spasm
