Sexual problems Flashcards
(Drive, desire, libido, excitation, orgasm, resolution)
Define Male Hypoactive Sexual Desire Disorder
Lack/loss of sexual desire
(doesnt mean loss of enjoyment - just less likely to happen)
Lack of thoughts/interest about sex
not secondary to any other causes
Causes of Male Hypoactive Sexual Desire Disorder
Medical - CVD, DM, obesity, anaemia
Hormonal - \/ Androgen, hypogonadism, ^prolactin, hypothyroidism (F - post-pregnancy, addisons)
Iatrogenic - SSRIs, finasteride, orchidectomy (F-COCP, HRT)
Psychiatric - depression, anxiety, past experiences (abuse), body image disorders, erotic dissatisfaction etc
Treatment options for Male Hypoactive Sexual Desire Disorder
Psychosexual treatment (gel to start, IM after) Testosterone replacement if low
Psychosexual treaments -Cognitive - what is it?
Addressing unhelpful thinking styles
Psychosexual treaments -behavioural - what is it?
ie Self growth - learning own needs/responses
understand and overcome unhelpful thinking patterns
sensate focus - making couple focus on the senses and intimacy rather than the sex - so no sex allowed - couple touch each other to get more comfortable with no pressure of sex
Psychosexual treaments -CBT- what is it?
combination of cognitive and behavioural therapies
Addressing unhelpful thinking styles
ie Self growth - learning own needs/responses
understand and overcome unhelpful thinking patterns
Psychosexual treaments - psychodynamic - what is it?
talking about how past events affect present
past events, abuse, partner choices transference etc
Psychosexual treaments - systemic - what is it?
individual - sexual education, encourage vocalisation of feelings, lessen performance anxiety etc
couple, family other types
Low testosterone symptoms
Low mood irritable aches, pains reduced cognition sexual problems
so IM testosterone can sort these out and make people feel much better
Define erectile disorder
= erectile dysfunction
struggle to get or maintain an erectile long enough for sex decrease in rigidity
Causes of erectile disorder
psychological
Biological
medical - CVD, DM, neurological sensation loss
hormones - low androgens, high prolactin
iatrogenic - SSRIs, antihypertensives, prostate surgery
Aging, pain
veno-occlusive disorder (penile veins don constrict properly)
porn (8month clear out)
depression, substance misuse
performance anxiety
Treatment for erectile disorder
1st line sildenafil (viagra) PO
(others - avanafil, tadalafil, vardenafil all PO)
ICI (intracavernous injection) -alprostadil
also can use vaccum device + penile ring
sildenafil - important patient information
need sexual stimulation to work still
work best on empty stomach
wait 45-60 mins before starting
efficacy improves with each dose up to 8th
define Female Sexual Interest/Arousal Disorder
failure of genital response
- vaginal dryness common presenting complaint
lack of/reduced sexual interest, thoughts, enjoyment etc
causes of Female Sexual Interest/Arousal Disorder
#biological medical - CVD, DM, neuro hormones - v-oestrogen, (menopause, thyroid) SSRIs breastfeeding vaginal dryness
#psychological depression, anxiety, binge eating, Hx abuse, v intimacy
define female orgasmic disorder
orgasm doesnt occur or is markedly delayed
not as intense etc
causes of female orgasmic disorder
biological medical- CVD, DM, neurological disorder hormones- v oestrogen/androgens (post menopause/hypothyroidism) pelvic floor weakness age SSRIs
psychological
depression, substance misuse
abuse, relationship problems, environment, stress
Menopause effects on sexual function
vaginal/pelvic pain vaginal atrophy dryness change in mood, self image, cognition, desire night sweats, sleeplessness
SSRIs for depression can affect sexual function. What drug is good for avoiding these side effects?
mirtazapine
define Rapid ejaculation
= premature ejaculation
ejaculation occurring too soon for both partners to enjoy their sex
causes of rapid ejaculation
genetic - penile hypersensitivity
hyperthyroidism
prostatitis
drugs
anxiety, early learned experiences
lack of experience, psychosexual/environmental factors
relationship issues
treatments for rapid ejaculation
topical anaesthetic dapoxetine couple psychosexual therapy behavioural therapy - sensate focus practice start stop, point of inevitability
define delayed ejaculation
marked delay or absence in ejaculation - without desiring it
causes of delayed ejaculation
psychological
#biological congenital, trauma, age, infection neurological causes - DM, myelopathy, alcohol neuropathy depression, SSRIs, etc low testosterone
IMPORTANT - need to exclude retrograde ejaculation [ejaculate going into bladder] (white/cloudy urine after sex/urinalysis for fructose/sperm)
technique/not aroused
v body image, Hx abuse, fear, relationship problems
management of delayed ejaculation
physical examination (testes, prostate etc)
FBC, HbA1C, testosterone, B12, folate, PSA
urinalysis for fructose/sperm
individual/couple therapy
kegal exercises
vibration/superstimulation
What is vaginismus
spasm of the pelvic floor muscles surrounding the vagina which occludes the vaginal opening and makes penetration difficult or impossible
often a response to pain
causes of vaginismus
things that cause pain - thrush, FGM etc
mistaken beliefs, fear of pregnancy, previous trauma, fear/dislike of partner/relationship
treatment for vaginismus
individual psychosexual therapy
CBT - for phobic reaction to sex
kegel exercises, vaginal trainers, breathing control/relaxation
what is dyspareunia
pain during intercourse - no primary cause
causes of dyspareunia
manipulation - infection, injury, hypersensitivity
introitus (pain on entry) - herpes, vaginal atrophy, dryness
mid-deep pain - endometriosis, congenital short vagina, surgical adhesions, constipation
pysch
previous experience of pain, abuse, stress, poor technique, fear of intimacy
management of dyspareunia
rule out any treatable cause (creams for dryness etc)
couple therapy
personal sexual growth program (PSGP)
sensate focus
couple therapy - cognitive behavioural therapy
focus on dysfunctional beliefs and behaviours in the present
psychodynamic couple therapy
focuses on early responses in life to things now affects present situation
places to refer people with sexual problems
Relate - help with any relationship problems
Porterbrook - problems with sexual relationships
COSRT- college of sexual and relationship therapists
SAA - sex addicts anonymous
lichen sclerosus
Lichen sclerosus (LS) is a chronic inflammatory dermatosis which usually affects the skin of the anogenital region in women, and the glans penis and foreskin in men
white thickened patches
itchy in women - not in men
can make sex etc painful
topical steroids help
what is vulvodynia
unexplained vulval pain
azoospermia
low sperm count
hypospadias
opening of penis on underside of penis not at the end
Peyronie’s disease
curved penis - after fracture of penis
fibrotic bands/plaques make it curved
