Sexual Problems Flashcards
In a psychosexual consultation what does
LOFTI stand for?
Listen - open qs, silence, tone, style, words
Observe - body language, behaviour, canellations, dress
Feelings - how does the patient make you feel
Thinking - doctor style in consultation (parent, teacher), why patient presented now
Interpret - overall picture, pt attitudes, defence mechanisms
Examples of defence mechanisms for psychosexual patients
Regression Dissociation Introjection Sublimation Denial Avoidance
Characteristic psychological pattern of women with chronic pelvic pain without a physical cause
Difficult childhood Poor parental affection Lack of parental interest Previous unsuccessful relationships Dysparunia Loss of libido Anxiety disorders / neuroticism
What is vaginismus
involuntary spasm of the pubococcygeal muscle and associated muscles
painful and difficult vaginal penetration
can be primary or secondary
what is vulvodynia
vulval discomfort / burning or pain in the absence of any visible findings
No specific identifiable cause or neurological disorder
Provoked or unprovoked
Classified according to genital site
What conditions are often associated with vulvodynia
psychological conditions
- anxiety
- depression
- somatisation
- hyperchondriasis
Management of vulvodynia
pelvic floor exercises external / internal soft tissue self massage with organic lubricants triger point pressure biofeedback vaginal trainers acupuncture lidocaine cream capsicum cream amitryptilline / gabapentin / pregabalin
what is hypoactive sexual desire disorder
loss of libido
decline in sexual desire
causing distress and interpersonal difficulties
Causes of hypoactive sexual desire disorder
Psychosexual causes depression menopause TCAs SSRIs chemotherapy radiotherapy ooporectomy
What is tokophobia
fear of pregnancy and childbirth
more common in primigravid women
anecdotally is increasing
Causes of primary tokophobia
primary tokophobia = in nullips / primips
- adolescence - reinforced to avoid pregnancy at all costs
- cultural attitudes
- family attitudes
- media
- childhood abuse
- adult abuse
Causes of secondary tokophobia
secondary tokophobia - after previous birth
- previous traumatic birth
- previous instrumental delivery
- spontaneous birth
- previous termination
- previous stillbirth / neonatal death
What factors should be explored in women with tokophobia?
triggering factors causes of concern - fear of pain - fear loss of control - fear of harm to self - fear of harm to baby - lack of support - concern about vaginal stretching - concern their anatomy is not normal
Causes of erectile dysfunction
Can be caused by physical or psychological problems.
Physical causes
- diabetes
- high blood pressure
- heart disease
- hormonal problems
- alcoholism
- serious illnesses such as cancer.
Psychological problems including
- stress,
- depression,
- previous negative experiences
- anxiety
- underlying relationship issues
Lifestyle changes to improve erectile dysfunction
Smoking cessation Healthy diet Reduce weight Exercise Reduce stress Reduce alcohol
