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3A REVISION > SEXUAL/REPRODUCTIVE MEDICINE > Flashcards

SEXUAL/REPRODUCTIVE MEDICINE Flashcards

1
Q

What is the triple swab assessment?

A

High vaginal swab
Endocervical swab
Chlamydia swab

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2
Q

What does high vaginal swab diagnose?

A

Trichomonas vaginalis, BV, candida, group b strep

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3
Q

What does endocervical swab diagnose?

A

Gonorrhoea

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4
Q

What is contact tracing?

A

Identification and notification of recent sexual contacts for screening and treatment, usually by patient

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5
Q

Asymptomatic female STI check? (3)

A

Self taken swab (can be clinician if preferred) for gonorrhoea and chlamydia
Bloods for syphilis and HIV
Test for hep B/C if at risk

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6
Q

Asymptomatic male STI check? (3)

A

First void urine for chlamydia and gonorrhoea
Bloods for syphilis and HIV
Hep b/c if at risk

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7
Q

Asymptomatic gay male STI check? (6)

A 
Throat swab 
First void urine
Rectal swab
Bloods for HIV and syphilis
Vaccine for hep b offered
Hep C if at risk
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8
Q

Symptomatic STI check? (10)

A

Examine external genitalia, swab from any ulcer/fissure for herpes
Female: Speculum exam of cervix if no herpes, clinician vaginal swab
Male: first void urine
Rectal, urethral, throat swabs if high risk for gonorrhoea
Bimanual exam if indicated
Bloods for syphilis and HIV
MSU if UTI/blood suspected
Pregnancy test if suspected
Hep/c if at risk

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9
Q

Symptoms of chlamydia trachomatis? (3)

A

Usually asymptomatic
Urethritis
Vaginal discharge

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10
Q

Complications of untreated chlamydia? (5)

A 
PID
Tubal damage 
Subfertility
Chronic pelvic pain
Reiter's syndrome - urethritis, arthritis, conjunctivitis
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11
Q

Management of chlamydia?

A

Azithromycin or doxycyline

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12
Q

Symptoms of neisseria gonorrhoeae? (5)

A 
Usually asymptomatic
Vaginal discharge
Urethritis
Bartholinitis
Cervicitis
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13
Q

Type of bacteria in gonorrhoea

A

Gram negative diplococcus

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14
Q

Complications of gonorrhoea? (2)

A

Bacteraemia

Septic arthritis

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15
Q

Treatment of gonorrhoea?

A

IM ceftriaxone

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16
Q

What are genital warts caused by?

A

HPV human papillomavirus

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17
Q

What types of HPV are associated with CIN?

A

16 and 18

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18
Q

Treatment of genital warts?

A

Cream - podophyllin

Cryotherapy or electrocautery

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19
Q

What is thrush?

A

Infection with candida albicans fungus, most common vaginal infection

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20
Q

Risk factors for thrush? (3)

A

Pregnancy
Diabetes
Antibiotics

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21
Q

Symptoms of thrush? (5)

A 
Cottage cheese discharge
Itching and irritation
Superficial dyspareunia
Dysuria
Inflammation
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22
Q

Treatment of thrush?

A

Topical imidazoles - clotrimazole

Oral fluconazole

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23
Q

What is bacterial vaginosis?

A

Normal lactobacilli in the vagina are overgrown by other mixed flora

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24
Q

Symptoms of bacterial vaginosis? (4)

A

Grey white discharge
Fishy odour
Raised pH
Clue cells on microscopy

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25
Q

Treatment of BV?

A

Metranidozole

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26
Q

What type of herpes commonly causes genital infection?

A

HSV2

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27
Q

Symptoms of primary herpes infection? (4)

A

Multiple small painful ulcers around the introitus
Lymphadenopathy
Dysuria
Systemic symptoms

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28
Q

Complications of herpes? (4)

A

Secondary bacterial infection
Aseptic meningitis
Acute urinary retention
Neonatal herpes has high mortality

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29
Q

Explain herpes reactivation?

A

After primary infection virus lies dormant in dorsal root ganglia
In 75% it reactivates
Secondary attacks are less painful and severe

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30
Q

Treatment of herpes?

A

Aciclovir

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31
Q

What causes syphilis?

A

Infection with treponema pallidum

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32
Q

Symptoms of primary syphilis?

A

Solitary painless vulvar or penile ulcer - chancre

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33
Q

What happens if primary syphilis is left untreated?

A

Secondary syphilis - rash, flu like symptoms, warts around genitals and mouth

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34
Q

What happens after secondary syphilis?

A

Latent syphilis

Tertiary syphilis many years later

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35
Q

Symptoms of tertiary syphilis?

A

Aortic regurgitation, dementia, neurological effects, skin and bone gummata (swellings)

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36
Q

Treatment of syphilis?

A

IM penicillin

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37
Q

What is trichomonas vaginalis?

A

Flagellate protozoan

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38
Q

Symptoms of trichomonas? (5)

A

Offensive grey-green discharge
Vulval irritation
Superficial dyspareunia
Cervicitis

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39
Q

Treatment of trichomonas?

A

Metronidazole

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40
Q

Risk factors for HIV? (4)

A

Multiple sexual partners
Migration from high risk countries
Lack of barrier contraception
IV drug use

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41
Q

What 2 gynae conditions are more common with HIV?

A

Candida

CIN

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42
Q

Management of HIV?

A

Antiretrovirals

C section and no breastfeeding if pregnant

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43
Q

What is seroconversion?

A

Time period in which a specific antibody develops and is present in the blood
In HIV, flu like symptoms and rash
Women commonly no symptoms

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44
Q

How is AIDS diagnosed?

A

Development of opportunistic infection or malignancy or a CD4 <200

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45
Q

What is contraception?

A

Prevention of pregnancy, some reduce spread of STIs

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46
Q

Is breastfeeding contraceptive?

A

If fully breastfeeding, amenorrheic, less than 6 months postpartum it is >98% effective

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47
Q

Contraceptive contraindications in breastfeeding?

A

Avoid COCP before 6 weeks PP, relatively contraindicated 6 weeks - 6 months
Progestogen only methods can be used

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48
Q

What is the COCP?

A

Combined oral contraceptive pill

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49
Q

How does the COCP work? (3)

A

Exert negative feedback effect on gonadotrophin release and inhibit ovulation
Thin the endometrium
Thicken cervical mucus

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50
Q

How is the COCP taken?

A

Daily tablet containing oestrogen and progesterone taken for 3 weeks, 1 week break with withdrawal bleed

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51
Q

Side effects of the COCP? (7)

A 
Depression
PMT symptoms
Bleeding or amenorrhoea
Acne
Weight gain
Breast pain
Reduced libido
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52
Q

Missed COCP advice?

A

1 pill - take as soon as possible and continue
2 pills - continue packet as normal but use condoms for 7 days
If less than 7 pills remaining, avoid break and start another pack

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53
Q

Complications of COCP? (6)

A 
Venous thrombosis
Myocardial infarction
Cerebrovascular accidents
Focal migraine
Hypertension
Cervical and breast carcinoma
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54
Q

Absolute contraindications to COCP? (10)

A 
History of VTE, CVA, IHD, severe hypertension
Migraine with aura
Active breast/endometrial cancer
Inherited thrombophiia
Pregnancy
Smokers >35 years and >15 a day
BMI >40
Vascular complications of diabetes
Active/chronic liver disease
Breastfeeding up to 6 weeks
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55
Q

Relative contraindications to COCP? (7)

A 
Smokers
Chronic inflammatory disease
Renal impairment
Diabetes
Age >40
BMI >35
Breastfeeding up to 6 months
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56
Q

What is the contraceptive patch?

A

Combined transdermal patch that releases oestrogen and progestogen, every week for 3 weeks then break

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57
Q

What is the contraceptive ring?

A

Nuvaring, releases daily dose of oestrogen and progestogen, worn for 3 weeks in the vagina then removed for 7 days and a new ring inserted after

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58
Q

What is the mini pill?

A

Progestogen only pill containing a slow dose of progestogen, taken every day without a break at the same time within 3 hours (cerazette within 12)

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59
Q

Contraceptive effects of the progestogen only pill?

A

Makes cervical mucus hostile to sperm

Inhibits ovulation in 50%

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60
Q

Side effects of the progesterone only pill?

A 
Vaginal spotting
Weight gain
Breast pain
PMT symptoms
Functional ovarian cysts
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61
Q

Missed progestogen only pill advice?

A

If missed for more than 3 hours, take as soon as possible and use condoms for 2 days

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62
Q

What are LARCs?

A

Long acting reversible contraceptives, not user dependent and highly effective

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63
Q

What is Depo-Provera?

A 
Medroxyprogesterone acetate (progestogen only)
IM injection every 3 months
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64
Q

Side effects of depo-provera? (4)

A

Spotting
Then amenorrhoea - may be prolonged after stopping
Progestogenic side effect as mini pill
Decrease bone density in first 2/3 months then stabilises, regained after stopping

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65
Q

What is the implant?

A

Nexplanon - rod containing progestogen inserted into the upper arm subdermally with anaesthetic, lasts 3 years

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66
Q

Side effects of the implant?

A

Progestogenic

Irregular bleeding

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67
Q

What is emergency contraception?

A

Drug or IUD used shortly after unprotected intercourse in an attempt to prevent pregnancy

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68
Q

What is the morning after pill?

A

Levonelle - single dose of progestogen, best taken within 24 hours can be up to 72
EllaOne - single dose selective progesterone receptor modulator, can be used up to 5 days after
Efficacy of both decreases with time

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69
Q

What is an IUD?

A

Intrauterine device, copper, prevents implantation, can be used up to 5 days after unprotected sex or as a LARC changed every 5-10 years

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70
Q

How do IUDs work?

A

Copper devices, operate by preventing fertilisation as copper is toxic to sperm and also blocking implantation

71
Q

What is an IUS?

A

Intrauterine system, progestogen released locally over 5 years

72
Q

How do IUSs work? (2)

A

Changes to cervical mucus and uterotubal fluid which impair sperm migration
Endometrial changes impeding implantation

73
Q

Complications of intrauterine device/system? (6)

A 
IUD - heavy bleeding
Pain/cervical shock
Expelled device
Perforated uterus
Risk of PID if current STI
Ectopic more likely if pregnancy occurs as blocked implantation in the uterus
74
Q

Considerations with IUD/IUS (6)

A 
Previous ectopic
Young/nulliparous
Pelvic infection
Endometrial/cervical cancer
Undiagnosed bleeding
Pregnancy
75
Q

Barrier methods of contraception? (3)

A

Male condom - sheath over the penis, afford best protection against disease
Female condom
Diaphragms and caps - fitted before sex and stay for 6 hours after, used with spermicide

76
Q

Permanent methods of contraception? (2)

A

Female sterilisation - clips on the fallopian tubes, hysterectomy if indicated
Male sterilisation - vasectomy more effective than female- ligation and removal of section of vas deferens preventing sperm passage

77
Q

What is natural family planning?

A

Using own body temperature, cervical mucus thickness, urinary hormones (LH, oestrogen) etc to predict ovulation and avoiding intercourse in specific times
Less effective

78
Q

What is the withdrawal method?

A

Removing penis just before ejaculation, not effective as sperm can be released before orgasm

79
Q

Define subfertility

A

Subfertility is when conception does not occur within a year of regular unprotected intercourse in the absence of known reproductive pathology - low chance of conception but may also be infertile

80
Q

Define primary and secondary subfertility

A

Primary if woman has never conceived

Secondary if previous pregnancy

81
Q

Causes of subfertility

A 
Male factor 30%
Female factor 30% (anovulation, tubal factors, PID)
25% Unexplained
10% combined
5% other
82
Q

Causes of anovulation (6)

A 
PCOS
Hypothalamic hypogonadism - low GnRH, low oestrogen
Hyperprolactinaemia - inhibits GnRH
Premature ovarian failure
Pituitary damage - LH, FSH
Hypo/hyperthyroidism
83
Q

How is hypothalamic hypogonadism treated?

A

Normal weight

Give gonadotrophins

84
Q

How is hyperprolactinaemia treated?

A

Give bromocriptine - inhibits prolactin

85
Q

What is second line treatment of subfertility once primary causes have been treated?

A

ART e.g. IVF

86
Q

Causes of male infertility (6)

A 
Drug exposure - alcohol, smoking, steroids
Varicocoele
Antisperm antibodies
Testicular abnormality
Obstructions i.e. of vas deferens in CF
Hypogonadism
Impotence
87
Q

Name 3 barriers to fertilisation

A

Tubal damage e.g. PID
Endometriosis
Previous surgery - adhesions

88
Q

When is ART considered (5)

A 
Other treatments failed
Unexplained cause
Male factor subfertility - ICSI
Tubal damage - IVF
Genetic problems
89
Q

Physiology of sperm production? (4)

A

Spermatogenesis in the testis is dependent on pituitary LH and FSH
LH stimulates testosterone production in Leydig cells in the testis
FSH and testosterone control Sertoli cells which synthesise sperm
Testosterone inhibits LH.

90
Q

Types of abnormal semen in men? (3)

A

Azoospermia - no sperm
Oligospermia - reduced levels of sperm
Asthenospermia - low motility

91
Q

Common causes of sperm abnormalities? (8)

A 
Smoking/alcohol/drugs/chemicals
Inadequate cooling of testis
Genetics
Antisperm antibodies
Infection - epididymitis
Klinefelters - XXY
Hypogonadotrophic hypogonadism
Retrograde ejaculation
92
Q

What is varicocoele?

A

Varicosities of the pampiniform plexus, usually on left, present in 25% of infertile men

93
Q

Management of male factor infertility?

A

Treat treatable causes
Optimise lifestyle factors
ART

94
Q

Investigations for female infertility? (6)

A 
Mid-luteal phase progesterone
Urinary LH
FSH, testosterone, prolactin, TFTs
USS
Hysterosalpingogram
Laparoscopy
95
Q

General treatment of infertility?

A

Lose weight
Folic acid
Treat treatable causes - i.e. clomifene, gonadotrophins, ovarian diathermy

96
Q

What is IUI?

A

Intrauterine insemination, sperm are injected directly into the cavity of the uterus timed with ovulation or after gonadotrophin ovulation induction

97
Q

When is IUI used?

A

Unepxlained subfertility

Mild-moderate sperm dysfunction

98
Q

What is IVF?

A

In vitro fertilisation, embryos are fertilised outside the uterus then transferred back

99
Q

When is IVF used?

A

If tubes not patent

Unexplained infertility

100
Q

How does IVF work? (5 stages)

A

Multiple follicular development - 2 weeks of gonadotrophin injections (FSH and LH)
With 21 day GnRH analogue to suppress pituitary and prevent LH surge before stimulation starts, or short daily GnRH antagonist from day 5 stimulation until egg collection
Ovulation and egg collection once follicles optimal size confirmed with scan - single dose LH given to trigger ovulation and collected under aspiration
Fertilisation and culture - eggs incubated with sperm and growth medium, spares can be frozen
Embryo transfer - best blastocyst transferred (can be 2 if indicated) and progesterone given for luteal support

101
Q

What is ICSI?

A

Intracytoplasmic sperm injection

102
Q

How does ICSI work?

A

Injection of one sperm into oocyte cytoplasm, adjunct to IVF when sperm are not motile

103
Q

What is oocyte donation?

A

Donor goes through ovarian stimulation and her eggs are fertilised with recipient’s partner’s sperm
Recipient given oestrogen and progesterone to prepare endometrium and embryo transferred

104
Q

What is surrogacy?

A

Another woman carries a biological child of the patients, when the patient has uterine problems or coexisting health issues so cannot carry a child

105
Q

What is ovarian hyperstimulation syndrome?

A

Occurs with gonadotrophin ovulation induction, in PCOS or IVF - use lowest effective dose

106
Q

Symptoms of OHSS? (5)

A 
Overstimulates the follicles which become large and painful
Hypovolaemia
Electrolyte disturbance
VTE
Pulmonary oedema
107
Q

Treatment of OHSS?

A

Admit for restoration of volume, monitoring, analgesia, thromboprophylaxis

108
Q

What is PGD?

A

Preimplantation genetic diagnosis, can remove a cell or 2 from the developing blastocyst in IVF and examine DNA to look for genetic mutation, unaffected embryos transferred

109
Q

When is PGD used?

A

Couples where single gene defects are carries (cystic fibrosis) or who have chromosome translocations so risk of an aneuploidic child high
Sex linked conditions

110
Q

What are the 4 broad categories sexual disorders fall into?

A

Chronic medical conditions
Hormonal
Iatrogenic
Psychiatric

111
Q

Investigations for sexual problems? (6)

A 
Fasting glucose/lipid ratio 
Testosterone, SHBG, albumin
Prolactin
TFTs
Oestrogen
FBC
112
Q

What is hypoactive sexual desire disorder?

A

Lack or loss of sexual desire, not secondary to physical problems, causing distress
Does not exclude sexual enjoyment or arousal but makes initiation less likely

113
Q

Causes of hypoactive sexual desire disorder? (9)

A 
Diabetes, CVD, obesity
Androgen deficiency
Hypothyroid
Hyperprolactinaemia
Depression/anxiety/trauma
Relationship issues
Substance abuse
Meds - COCP, tamoxifen, antidepressants
Post surgery or birth
114
Q

4 psychosexual treatment options?

A

Integrative - combination of psych and physical
CBT
Psychodynamic - past events, attachments
Systemic - individual, couple, family

115
Q

Treatment of hypoactive sexual desire disorder?

A

Testosterone replacement for males
Flibanserin for women
Psychosexual - CBT etc.

116
Q

What is erectile disorder?

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

117
Q

Causes of erectile disorder? (6)

A

CVD, Diabetes, Neuro conditions (cauda equina, MS)
Low androgen, high prolactin
Post surgery, antidepressants
Age
Ineffective sexual stimuli, relationship problems
Pain

118
Q

Treatment of erectile disorder?

A

Phosphodiesterase inhibitors - sildenafil
2nd line alprostadil injection or intraurethral
Vacuum device, rings
Psych treatments

119
Q

Side effects and contraindications of sildenafil?

A

Headaches, flushing

CI - Hypotension, recent unstable angina

120
Q

What is female sexual arousal disorder?

A

Failure of genital response (mainly vaginal dryness) and reduced interest in sexual activity, response to sex stimuli and reduced pleasure

121
Q

Causes of female sexual arousal disorder? (5)

A 
Diabetes, CVD, neuro
Oestrogen deficiency i.e. menopause
SSRIs
Lactation
Psychological
122
Q

Treatment of female sexual arousal disorder?

A

Behavioural - sensate focus, eros therapy devise, lubricants

Psychosexual couples therapy

123
Q

Common psychological causes of sexual problems? (8)

A 
Depression/anxiety
Substance misuse
Previous abuse or trauma
Couples script problems
Decreased intimacy
Relationship problems
Stress
Cultural/religious problems
124
Q

What is sensate focus?

A

Behavioural intervention
Programme of exercises to enable couple to identify sexual likes and explore new techniques
Overcome negative thinking patterns

125
Q

What is eros therapy?

A

Handheld device used for greater clitoral and genital engorgement, increased vaginal lubrication

126
Q

What is female orgasmic disorder?

A

Orgasm either does not occur or is markedly delayed, reduced intensity

127
Q

Causes of female orgasmic disorder? (6)

A 
CVD, Diabetes, neuro
Oestrogen/androgen insufficiency
Pelvic floor weakness
Age
SSRIs
Psych problems
128
Q

Treatment of female orgasmic disorder? (3)

A

Topical oestrogen
Education, guided masturbation, vibrators
Psychotherapy - attitudes to sex

129
Q

How does the menopause affect sexual function? (6)

A 
Vaginal/pelvic pain
Vaginal atrophy
Dryness
Change in self image
Change in desire
Sleeplessness, night sweats
130
Q

What is sexual aversion disorder?

A

Disorder characterised by disgust, fear, revulsion, or lack of desire in relationships

131
Q

Causes of sexual aversion?

A

Past trauma

Interpersonal problems - infidelity, violence, lack of hygiene of partner

132
Q

Treatments of sexual aversion? (3)

A

Psychotherapy
Couples counselling
Medications for anxiety

133
Q

What is rapid ejaculation?

A

Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Persistent
1 minute after vaginal peneration

134
Q

Cause of rapid ejaculation? (5)

A 
Genetic susceptibility
Hyperthyroid
Penile hypersensitivity
Comorbid erectile dysfunction
Performance anxiety, lack of experience, trauma
135
Q

Treatment of rapid ejaculation? (4)

A

Topical local anaesthetic STUD 100
SSRIs - dapoxetine
Couples therapy
Behaviour - Stop/start technique, sensate focus

136
Q

What is delayed ejaculation?

A

On almost all occasions without the individual desiring there is a marked delay (>30min) in ejaculation or infrequent/absent ejaculation

137
Q

Causes of delayed ejaculation? (8)

A 
Congenital disordres
Trauma/surgery
Age
Infection
Neuro disorders
Depression/other psych
SSRIs
Low testosterone
138
Q

Treatment for delayed ejaculation? (3)

A

Individual and couples therapy
Kegel exercises
Use of vibration/superstimulation

139
Q

What is retrograde ejaculation?

A

Entry of semen into the bladder instead of going out through the urethra during ejaculation, causes aspermia

140
Q

Cause of retrograde ejaculation? (4)

A

Malfunction of bladder sphincter - autonomic nervous system dysfunction, TURP (prostate surgery)
Nerve damage
S/e of tamsulosin, antidepressants
Diabetes

141
Q

Investigations of retrograde ejaculation?

A

Urine sample for presence of sperm and fructose - disinguishes between this and anejaculation

142
Q

Treatment of retrograde ejaculation? (5)

A 
Some untreatable - if radiation damage, cut nerves from surgery
Tricyclic antidepressants
Antihistamines
Decongestants - ephedrine
Infertility treatments
143
Q

What is anejaculation?

A

Pathological inability to ejaculate in males, with or without orgasm

144
Q

Causes of anejaculation? (7)

A 
Sexual inhibition
Medications - SSRIs. antipsychotics
Autonomic nervous system
Prostate surgery
Duct obstruction
Spinal cord injury
Old age
145
Q

Treatment of anejaculation? (3)

A

Penile vibratory stimulation

Electroejaculation, percutaneous epididymal sperm aspiration for sperm removal

146
Q

What is vaginismus?

A

Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening, penile entry is painful/impossible

147
Q

Causes of vaginismus? (5)

A

Irritated vulva - thrush, lichen sclerosis
Painful conditions
FGM
Congenital abnormality
Psych - fear, religious issues, previous trauma, relationship issues

148
Q

Treatment of vaginismus?

A

Psychosexual therapy

Self exploration, vaginal dilator, graded penetration

149
Q

What is dyspareunia?

A

Pain during intercourse, occurs in women and men, if there is no primary nonorganic sexual dysfunction

150
Q

Cause of dyspareunia in women? (6)

A 
STIs
Episiotomy
Vaginal atrophy
Pelvic inflammatory disease
Endometriosis
Psych issues
151
Q

Cause of dyspareunia in men? (4)

A

STIs
Urethral strictures
Varicocoele
Psych issues

152
Q

Treatment of dyspareunia?

A

Treat cause
Lubricants
Couples therapy
Behavioural therapy - sensate focus

153
Q

What is vulvodynia?

A

Chronic pain syndrome affecting the vulvar area, occurs without an identifiable cause

154
Q

Cause of vulvodynia? (6)

A

History of STIs
Sjogrens syndrome
Autoimmune disorders causing inflammation
Eczema
Former oral contraceptive use before age of 16
Injury/neuropathy

155
Q

Treatment of vulvodynia? (5)

A 
Lubricants
Psychotherapy
Oestrogen creams/lidocaine cream
Amitriptyline, gabapentin
Vestibulectomy surgery - cut nerves
156
Q

What is aspermia?

A

Complete lack of semen with ejaculation

157
Q

Causes of aspermia? (4)

A

Retrograde ejaculation
Ejaculatory duct obstruction
Androgen deficiency
Treatment of prostate cancer - maximal androgen blockade

158
Q

What is Peyronie’s disease?

A

Development of fibrous scar tissue inside the penis that causes curved, painful erections - can cause erectile dysfunction

159
Q

Cause of Peyronie’s disease? (4)

A

Repeated injury and disorganised healing
Genetics
Connective tissue disorders
Age

160
Q

Treatment of Peyronie’s disease? (3)

A

Pentoxifylline to reduce scar tissue
Penile injections - collagenase, verapamil, interferon (break down fibrous tissue)
Surgery to suture unaffected side, excise tissue, implants

161
Q

What is hypospadias?

A

Congenital condition in males in which the opening of the urethra is on the underside of the penis, normally diagnosed at birth

162
Q

Treatment of hypospadias?

A

Surgical correction

163
Q

What is sex?

A

Male/female based on external genitalia

164
Q

What is gender identity?

A

Intrinsic sense of being male/female/alternative

From genes, oestrogen, testosterone on developing brain

165
Q

What is gender expression?

A

Personality, appearance, behaviour in a cultural and historical context

166
Q

What are primary and secondary sex characteristics?

A

Primary - penis and scrotum and testis maturation, vagina/vulva/ovary maturation
Secondary - enlargement of genitalia, pubic and armpit hair, breast development, voice pitch lowering in men

167
Q

What is transgender?

A

Diverse gender variance including transsexual/agender/genderqueer

168
Q

What is gender dysphoria?

A

Distress due to incongruence between gender identity and sex assigned at birth

169
Q

What is transsexual?

A

Individuals who seek to change their primary/secondary sex characteristics

Transmale - female at birth changing to male
Transfemale - male at birth changing to female

170
Q

What is sexual orientation?

A

Sex of persons to whom sexual fantasies, arousal, activities directed

171
Q

When are the external genitalia and gonads developed?

A

8 weeks

172
Q

How does masculinisation occur?

A

SRY gene - testes development

Mullerian inhibiting substance

173
Q

Management for transmale?

A 
Fertility options
Androgens +/- GnRH analogue
Voice
Male chest reconstruction
Hysterectomy and bilateral oophorectomy
Phalloplasty
174
Q

Management for transfemale?

A 
Fertility options
Oestrogens and antiandrogens
Voice
Facial hair removal
Vaginoplasty
Mammoplasty
Facial feminisation surgery

3A REVISION (17 decks)

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