Sexual wellbeing Flashcards
Physiology of female sexual response
4 phases to sexual response:
- excitement (PNS = P = Point – erection/arousal)
- plateau,
- orgasm (SNS)
- resolution
What is the responsible neurotransmitter for arousal -> clitoral swelling due to increased blood flow
Nitric oxide
Organic causes of sexual dysfunction to rule out before targeting psychosexual health:
Thyroid
Sleep disorders
Mood
Vascular – ask about morning/ nocturnal erections
–> Erections effected earlier»_space; systemic vascular symptoms, may be first presentation
Diabetes – check blood sugars (impact via autonomic neuropathy)
Gynaecological problems
» Pain/vaginismus from previous assault or FGM
» Discomfort relating to a prolapse or peri-menopausal skin changes/dryness
Prostate / LUTS
Discomfort secondary to STI – full screening
Drug history – anticholinergics, antipsychotics, antidepressants, OCP (all interfere with libido)
Recreational drugs including chem sex (high incidence of psychosexual difficulties in chem users)
»Competition/ pressures to last a long time, reliance on chems for sexual activity
Stress/ adjustment i.e. following new diagnosis of HIV / HSV etc
Relationship context – are there relationship problems contributing?
Drugs with adverse effect on sex function
Antihistamines
(diphenhydramide, hydroxyzine)
Antiparkinsonian agents (Benztropine)
Antidepressants
Antipsychotics
Antiarhythmics
Antimuscarinics
Antiemetics (prochlo and prometh)
Antispasmodics
Vaginismus
Involuntary contraction of vaginal introital and levator ani muscles (pelvic floor)
Pain-tension-pain cycle –> fear and avoidance
CBT, pelvic floor physiotherapy, desensitising / tolerance approach i.e. dilators
Vulvodynia
Topical agents (lidocaine preparations) and touch tolerance exercises
NB: when tricyclic antidepressants such as amitriptyline are used for chronic pain, it can take ~ 6 weeks for them to become effective
ED
Sildenafil mechanism = phosphodiesterase inhibitor
Specifically cGMP phosphodiesterase type 5 – PDE5 inhibitor
–> Inhibits breakdown of cGMP (cyclic guanosine monophosphate)
–> More cGMP present in corpus cavernosa erectile tissue of the penis
–> Increases smooth muscle relaxation and vasodilation to potentiate erection
Sexual stimulation is required for sildenafil to produce intended pharmacological effects/ benefits
Potentiates the hypotensive effects of nitrites –> prolonged and dangerous hypotension (do not use)
Not recommended for use alongside ritonavir (protease inhibitor) as may potentiate adverse effects
» If concurrent use unavoidable dosage should be adjusted (reduced)
Contraindications:
Recent MI/ stroke/ unstable angina/ systolic BP <90
H/o non-arteritic anterior ischaemic optic neuropathy OR degenerative retinal disorders
Legislation related to rape and other sexual offences
Sexual Offences Act 2003 (England)
The Sexual Offences (Northern Ireland) Order 2008 – very similar to the above
Statutory definition of rape
RAPE IS COMMITTED WITH A PENIS, AND CANNOT BE COMMITTED WITH AN OBJECT
A person (A) commits an offence if:
(a) He intentionally penetrates the vagina, anus or mouth of another person (B) with his penis, (b) B does not consent to the penetration, and (c) A does not reasonably believe that B consents
Whether a belief is reasonable is to be determined having regard to all the circumstances, including any steps A has taken to ascertain whether B consents
13 years deemed unable to consent
Statutory definition of assault by penetration
A person (A) commits an offence if:
(a) He intentionally penetrates the vagina or anus of another person (B) with a part of his body or anything else
(b) The penetration is sexual (c) B does not consent to the penetration, and (d) A does not reasonably believe that B consents.
Whether a belief is reasonable is to be determined having regard to all the circumstances, including any steps A has taken to ascertain whether B consents.
A person guilty of an offence under this section is liable, on conviction on indictment, to imprisonment for life.
Statutory definition of Sexual assault
A person (A) commits an offence if:
(a) He intentionally touches another person (B),
(b) The touching is sexual,
(c) B does not consent to the touching, and
(d) A does not reasonably believe that B consents.
Whether a belief is reasonable is to be determined having regard to all the circumstances, including any steps A has taken to ascertain whether B consents.
A person guilty of an offence under this section is liable:
(a) On summary conviction, to imprisonment for a term not exceeding 6 months or a fine not exceeding the statutory maximum or both;
(b) On conviction on indictment, to imprisonment for a term not exceeding 10 years (not exceeding 14 years if sexual assault of a child <13 years).
Sexual activity with a child - ages
Sexual activity with a child, perpetrator must be >18 and ‘child’ must be <16
If position of trust perpetrator must be >18 but ‘child’ can be <18
LAW: Administering a substance with intent
A person commits an offence if he intentionally administers a substance to, or causes a substance to be taken by, another person (B):
(a) Knowing that B does not consent, and (b) With the intention of stupefying or overpowering B, so as to enable any person to engage in a sexual activity that involves B.
A person guilty of an offence under this section is liable to imprisonment/ fine as per sexual assault (6 months +/- fine –> 10 years)
Soliciting
It is an offence for a person in a street or public place to solicit another (B) for the purpose of obtaining B’s sexual services as a prostitute.
- The reference to a person in a street or public place includes a person in a vehicle in a street or public place.
- A person guilty of an offence under this section is liable on summary conviction to a fine not exceeding level 3 on the standard scale.
Locard’s principle
Locard’s principle holds that the perpetrator of a crime will bring something into the crime scene and leave with something from it, and that both can be used as forensic evidence
DNA detection from samples taken via FME utilises this principle
SARC/ FME timeframe
If SA in last 14 days discussion of SARC attendance for FME / sample collection / documentation of any injuries should be had, even if the patient does not want to report the assault to the police at this time.
Best within a 72 hours window
Site of assault and timeframe for DNA evidence collection
Vaginal
7 days
Anal
72 hours
Oral
48 hours
Skin
48 hours
Digital penetration only
48 hours *(faculty of forensic legal medicine – BASHH states 12 hours only but all other sources agree 48)
Blood for toxicology testing if suspicion of spiking
72 hours
Urine for toxicology if suspicion of spiking
14 days
Documentation of injuries, if present
21 days
EXAMINE tho if need EC or emergency med care
How long can SARC/FME samples be stored?
samples collected (DNA samples and clothing) can be stored via SARC services for up to 2 years
For paediatric SARC this storage period is extended up to the age of 18 or for a period of 10 years (whichever longer)
SARC and Human tissues act 2004
If pregnancy occurs and sampling of tissue
Evidence seized by police for criminal investigation purposes is excluded from the Human Tissue Act 2004 (HTA) regulations and
DNA testing can be performed without the consent of the alleged attacked, as well as allowing for samples to be stored on premises that are not licensed by the HTA (Section 39 exemption)
How to collect samples so that they stand in court
for any samples to be able to be used as evidence in court following sexual assault/ rape they must be collected and processed using CHAIN OF EVIDENCE techniques to ensure they could not have been tampered with /contaminated
