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Sexual Medicine > Sexual problems > Flashcards

Sexual problems Flashcards

1
Q

What blood tests are useful in assessing sexual health

A

Fasting Glucose/Lipid ratio
Diabetes/CVD, useful to rule out for most sexual problems

Testosterone, SHBG, albumin
Desire disorders, arousal disorders, orgasmic disorders, pain disorders

Prolactin
Desire disorders, ED

TSH
Desire disorders, rapid ejaculation

Oestrogen
Female sexual arousal disorder, orgasmic disorder

FBC
Desire disorders, orgasmic disorders

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2
Q

What is male hypoactive disorder

A

Lack or loss of sexual desire.

Loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not preclude sexual enjoyment or arousal, but makes the initiation of sexual activity less likely.

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3
Q

What are the physiological causes of hypoactive sexual desire disorder

A

obesity
CVD
diabetes mellitus
anaemia

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4
Q

What are the hormonal causes of hyposexual desire disorder in men

A

Androgen deficiency
Hypogonadism from various aetiologies
Hyperprolactinameia

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5
Q

What are the hormonal causes of hyposexual desire disorder in females

A 
Androgen deficiency
Hypothyroidism
Hyperprolactinaemia
Post pregnancy
Addison’s disease
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6
Q

What are the pharmacological and surgical causes of HSDD in men

A

anti-depressants and finasteride

orchidectomy

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7
Q

What are the pharmacological and surgical causes of HSDD in women

A

oral contraceptive, oral HRT, tamoxifen (all bind with testosterone), anti-depressants & anti-psychotics, b-blockers.

bilateral oophrectomy

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8
Q

What are the psychological causes of HSDD

A

Mental health conditions, e.g. depression, anxiety, substance misuse
Psychological experiences, e.g. environmental, life events (including work stressors), previous trauma or abuse
Body image disorder
Couples script problems
Erotic dissatisfaction
Couple relationship problems

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9
Q

What are the psychosexual treatments options

A

cognitive = to address unhelpful thinking styles

behavioural = sensate focus or self growth programme

CBT

psychodynamic

systemic

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10
Q

What are the HSDD treatment options

A

testosterone replacements (injections, transdermal patches or gel, buccal, subcutaneous implants)

Individual psychosexual therapy

sexual growth programme

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11
Q

What is erectile disorder

A

difficulty in developing or maintaining an erection suitable for satisfactory intercourse

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12
Q

What can physiologically cause ED

A

chronic health conditions - CVD, DM, neurological disease

Hormonal disorders - androgen deficiency, high prolactin

Iatrogenic - post postrate surgery, prescribed medications (antihypertensives, antidepressants especially SSRIs)

Age related changes
ineffective sexual stimuli
pain
veno-occlusive disorder

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13
Q

What psychological factors could cause ED

A

Mental health conditions e.g. depression, anxiety, substance misuse
Performance anxiety, life events and negative previous experiences, unhelpful use of pornography
Couples script problems
Relationship problems or issues from previous relationship
Educational matters
Cultural and Religious matters

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14
Q

What are the medication options for ED

A

oral - sildenafil, avanafil, tadalafil, vardenafil

injectable - alprostadil

intraurethral - alprostadil

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15
Q

What are the non-medical options for ED

A

vacuum device
penile/scrotal rings
new stimulating routines
kegel exercises

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16
Q

What is female sexual interest/arousal disorder

A

lack of, or significantly reduced sexual interest or arousal

17
Q

What can cause female sexual interest/arousal disorder

A

Chronic medical conditions
oestrogen deficiency (post menopause, thyroid disorders)
medications - e.g. antidepressants
lactation
vaginal dryness from local irritants and douching

18
Q

What psychological factors can cause FSI/AD

A

Mental health conditions -Depression, anxiety, binge eating disorders, excessive dieting

Previous abuse
Couple script problems
Decreased intimacy
Couples relationship problems

19
Q

What are the treatments for FSI/AD

A

couples psychosexual therapy

behavioural interventions

20
Q

What is female orgasmic disorder (OD)

A

orgasm does not occur or is markedly delayed

21
Q

What causes OD

A

chronic health conditions

Oestrogen and/or androgen insufficiency (e.g. post menopause), hypothyroidism

Pelvic floor weakness or damage
Ageing
Prescribed medication especially SSRIs

22
Q

What are the effects of menopause on sexual function

A

Vaginal or pelvic pain
Vaginal Atrophy
Dryness
Change in self image, mood, memory, cognition
Changes in desire
Relationship, psychosocial and health factors play their part
Physical discomfort – sleeplessness, night sweats

23
Q

What is rapid ejaculation

A

the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction

24
Q

What are the physiological causes of rapid ejaculation

A 
genetic susceptibility
penile hypersensitivity
hyperthyroidism 
prostatitis 
co-morbid sexual problems 
sympathomimetic medication
25
Q

What are the psychological causes of rapid ejaculation

A 
anxiety states
early learned states
lack of experience/infrequent sexual activity
psychosocial and environmental factors
relationship issues
partner issues
26
Q

What are the treatment options for rapid ejaculation

A

topical local anaesthetic
Dapoxetine (SSRI off license)

couple psychosexual therapy
behavioural interventions - stop start/ squeeze technique

27
Q

What is delayed ejaculation

A

marked delay in ejaculation or marked infrequency or absence of ejaculation

28
Q

What can cause delayed ejaculation

A 
congenital disorders
trauma/surgery
age
infectious diseases
Neurological disorders - Diabetes, spinal cord injury, alcohol neuropathy
depression
medication - SSRI, phenothiazides, alpha blockers
low testosterone
29
Q

What investigations are done for delayed ejaculation

A

external examination
Bloods: FBC, glucose, testosterone, B12, folate, PSA
urine sample to rule out retrograde ejaculation (presence of spermatozoa and fructose)

30
Q

What treatment options are there for delayed ejaculation

A 
PSGP
individual therapy
couples therapy
kegel exercises
use of vibration/ superstimulation
31
Q

What is vaginismus

A

spasm of the pelvic floor muscles that surround the vagina causing occlusion of the vaginal opening. penile entry is either impossible or painful

32
Q

What are the physiological causes of vaginismus

A

medical conditions causing pain in the vulva e.g. thrush
FGM
congenital abnormality

33
Q

What are the psychological causes of vaginismus

A 
misinformation and mistaken beliefs
religious or cultural issues
fear of pregnancy
previous sexual abuse/trauma
fear or dislike of partner
relationship dissatisfaction
34
Q

What are the psychosexual treatment options for vaginismus

A

individual psychosexual therapy
integrated CBT
behavioural interventions - vaginal trainers

35
Q

What is dyspareunia

A

pain during intercourse

36
Q

What are the psychological causes of dyspareunia

A

Previous experience of pain
Previous sexual abuse
Poor sexual education
Poor understanding of anatomy and physiology
Insufficient relaxation
Painful or unpleasant Gynaecological examination

37
Q

What are the four main relationship therapy approaches

A

cognitive-behavioural
psychodynamic
systemic
integrative

38
Q

What does CB -relationship therapy focus on

A

dysfunctional patterns of thoughts, beliefs and behaviour in the here and now

39
Q

What does psychodynamic relationship therapy focus on

A

the relationship between current problems and earlier patterns of response and behaviour from earlier life and takes into account unconscious processes

Sexual Medicine (2 decks)

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