Sexual response, contraception, menopause and ethics Flashcards
what is gender identity and gender expression?
gender identity- the personal sense of ones own gender. it can correlate with ones assigned gender or differ from it
gender expression- the way a person communicates their gender based on societal factors such as gender norms and perceptions
what is gender dysphoria?
the unease or discomfort that a person may feel due to a mismatch in their anatomical sex and their gender identity
what is a vasectomy?
a small amount of the vas deferens is removed or cut and sealed by cautery. it can be a method of regulating male fertility as a form of contraception
what is the mechanism of action of the combined oral contraceptive?
prevents ovulation- suppression of gonadotrophin
inhibits sperm transport- alters cervical mucus
surpasses endometrial growth- prevents implantation
interferes with normal motility/ function of the Fallopian tubes
what are the grounds upon which an abortion can take place?
the pregnancy has not exceeded its 24th week
the pregnancy could cause grave permanent injury to the physical or mental health of the woman
the continuance of the pregnancy involves risk to the life of the pregnant woman
there is substantial risk that if the child were born it would suffer from serious physical or mental abnormalities
does a practitioner have a duty to carry out the abortion?
a practitioner does not have to take part in any procedure to which they have a conscientious objection but they must make prompt referral to another medical provider
what are the emotional issues related to termination of pregnancy?
women may feel grief, regret, anxiety or distress but some may feel a sense of relief and gratitude
what is a QALY?
quality adjusted life years is a generic measure of the burden of a disease, including both the quality and quality of the life lived. they can often be used when considering the impact of an intervention and cost per QALY can be used to assess the cost effectiveness of an intervention. it is calculated by multiplying the life expectancy with a quality of life score (from 0 to 1)
what are the symptoms of menopause?
hot flushes/night sweats, menstrual irregularities, difficulties sleeping, reduced sex drive, vaginal dryness, recurrent UTIs,, changes to memory/ mood, headaches
how can menopause affect someones life?
can impact relationships/ sex life
can impact work life- tiredness, low mood, difficulty concentration
ability to exercise or do certain activities- stiff joints hot flushes
how does menopause affect the hormonal changes during a cycle?
there is the same pulsatile release of GnRH which acts of the anterior pituitary stimulate FSH release. however there are no eggs in the ovary so folliculogenesis does not occur and there is no oestrogen release of LH surge.
what are the benefits of HRT?
- symptom control- particularly vasomotor and vaginal dryness
- reduces risk of osteoporosis
- improved muscle mass
- menstrual cycle control- some cases
what are the side effects of HRT?
fluid retention, nausea, headaches, breast tenderness, cramps
progesterone- irregular bleeding, PMS, bloating, depression
what is the mechanism of action of alkylating agents?
they covalently bind to alkyl groups in the nucleotide guanine causing cross linking of DNA which inhibits DNA replication and transcription causing cell cycle arrest and apoptosis
Cyclophosphamide- leukaemias, lymphoma, solid tumours
chlorambucil- lymphoma and chronic leukaemia
what is the mechanism of action of platinum based agents
bind to guanine and cause cross linking of DNA inhibiting DNA replication and transcription.
cisplatin
what is the mechanism of action of anti- metabolites?
interfere with the normal metabolism of nucleic acids which causes depletion of the availability of nucleic acids for DNA replication
5 fluroriracil blocks thymidylate synthase which is used in pyrimidine synthesis (T and C)
methotrexate blocks DHFR which is involved in purine synthesis
what is the mechanism of action of anthracyclines?
1) inihibit topoisomerase II
2) indirectly inhibits helices by intercalating into DNA
3) produces reactive oxygen species which induce DNA/ cell damage and causes apoptosis
doxorubicin, epirubicin, idarubicin
what is the mechanism of action of antimicrotubules?
target the mitotic spindle which is required for mitosis vinca alkaloids (vincristine, vinblastine)- prevent the assembly of the mitotic spindle taxanes (docetaxel, paclitaxel) - prevent mitotic spindle from contracting
what is tamoxifen and what is its mechanism of action?
tamoxifen is a hormone antagonist- selective estrogen receptor modulator.
it is a a competitive inhibitor of estradiol binding to oestrogen receptor (ER). ER is a major driver of cancer growth and survival in ER positive breast cancers so inhibiting this receptor will reduce cell proliferation
what is imatinib and what is its mechanism of action?
imatinib is a protein kinase inhibitor.
it inhibits the oncogenic protein kinase BCR-ABL which is a uniques factor in the pathogenesis of chronic myeloid leukaemia. it inhibits ATP binding of BCR-ABL oncoprotein preventing phosphorylation and activation of signalling pathways
how does BCR-ABL contribute to the pathogenesis of chronic myeloid leukaemia?
ABL and BCR are normal genes on chromosome 9 and 22 which code for protein kinases whose activities are tightly regulated. a translocation can occur which causes fusion of the BCR and ABL genes. this new gene encodes for a protein with deregulated tyrosine kinase activity which causes pathogenicity.
what are PD-1 immune checkpoint inhibitors and what is their mechanism of action?
they are a type of immunotherapy which activates the bodies immune system against cancer cells. cancer cells over express PD-L1 on their surface which binds to the PD-1 receptor on T cells and deactivates them so the cancer can evade immune attack. PD-1 immune checkpoint inhibitors block this checkpoint and let the body continue its attack. PD-1 receptor antagonists prevent the tumour cell binding to PD-1 so the T cell remains active.
pembrolizumab, nivolumab
what are the major pharmakokinetics and side effects of anti- cancer drugs?
the half life of a drug determines the dosing regime- tend to dose high (close to toxicity), and as often as possible to prevent the cancer regrowing
side effects- hair/skin (allopoecia, rashes), mucosal linings (nausea, ulcers, constipation, diarrhoea), gonadal function (infertility), bone marrow- reduced erythrocytes, leukocytes, platelets (anaemia, infection, bleeding)
what are the stages of the sexual response?
excitement, plateau, orgasm, resolution
what are the 3 types of female sexual dysfunction?
sexual interest disorders, female orgasmic disorders, sexual pain disorders
what are causes of female sexual dysfunction?
psychological- anxiety, depression, past trauma
vascular- atherosclerosis can impact the ability for the clitoris to become engorged
neurological- disorders of CNS, PNS
endocrine- oestrogen insufficiency, thyroid disease, diabetes
pregnancy and postpartum period
chronic pain
medications
what is dyspareunia?
the sensation of pain during sexual intercourse. can be superficial (infection, vaginismus), or deep pain (inflammation of vagina or cervix, fibroids, PID). can be psychological
what are the management options for female sexual dysfunction?
non-pharmacological- lifestyle changes, CBT, pelvic floor exercises, vaginal dilators (vaginismus)
pharmacological- vaginal lubricant, oestrogen preparations (post menopausal)
what type of nerve fibre is responsible for erection?
parasympathetic
what type of nerve fibre is responsible for ejaculation?
sympathetic
what is the mechanism of erection?
parasympathetic nerve fibres release acetylcholine which acts on muscarinic receptors causing activation of nitric oxide synthase. this produces NO which activates guanylate cyclase in smooth muscle cells which converts GTP to cGMP. cGMP causes calcium levels in smooth muscle cells to fall causing relaxation. this relaxation allows cavernosal spaces to expand and fill with blood. the pressure of the blood compresses veins trapping blood inside the copora and the erectile tissue becomes engorged
what are some causes of erectile dysfunction?
psychological
vascular- atherosclerosis of penile arteries, hypertension- damage to endothelial cells, cant make NO, hyperglycaemia- hyaline deposits in arterioles
neurological- MS, stroke, nerve damage
endocrine- low testosterone
what are the management options for erectile dysfunction?
treat associated disease lifestyle changes, CBT vacuum erection device PDE-5 enzyme inhibitors- leads to higher levels of cGMP prostaglandin E1 injections penile implants
what is the causative agent of chlamydia?
chlamydia trachomatis
what are the symptoms of chlamydia?
pain while peeing, discharge, women- pain in tummy, bleeding after sex/between periods, men- swollen, painful testicles
what is the treatment for chlamydia?
doxycycline: 100mg twice daily for 7 days
what is the causative agent of gonorrhoea?
neisseria gonnorrhoeae
what are the symptoms of gonorrhoea?
men- urethritis (mucopurulent discharge), dysuria
women- endocervical infection ( abnormal discharge), PID
neonates- swelling and discharge from eyes
what is the treatment for gonorrhoea?
ceftriaxone- 500mg intramuscular single dose plus azithromycin 1g oral single dose
what is the causative agent of syphilis?
treponema pallidum
what are the symptoms of syphilis?
primary syphilis- primary lesion (chancre) at site of inoculation 3 weeks after exposure, disappears without treatment
secondary syphilis- red, maculopapular rash on any region of body 6 weeks after primary lesion, condylomata lata - wart like lesions in anogenital region
tertiary syphilis- dementia, gummata- inflammatory nodules/plaques, locally destructive, found on skin, bone
what is the treatment for syphilis?
Intramuscular benzathine benzylpenicilin
what is the causative agent of anogenital warts and where can they occur?
HPV
they commonly occur in the genial, perianal and anal regions. can also occur in urethral meatus, vagina, cervix, and anal canal
