Sexuality and Male Sexual Health Flashcards
paraphilias
sexual arousal and gratification depend on fantasizing about and engaging in sexual behavior that is atypical and extreme
Define “biological sex”
anatomy; internal and external sex organs, chromosomes, hormones
female, male, intersex
Define sexual orientation
An individual’s physical and/or emotional attraction to a certain gender
lesbian, gay, straight, bi, asexual, queer
Kinsey scale
evaluating sexual orientation
0 = exclusively heterosexual 1 = incidental homosexual 3 = equally hetero and homo 6 = exclusively homosexual
Gender identity
innate, deeply felt identification as man, woman, or other
may or may not correspond to sex assigned at birth
girl/woman, boy/man, transgender
sexual behavior
how and with whom (or what) we have sex
hetero, homo, bisexual, celibate
What are different types of normal?
statistical (majority of people do it) religious/moral psych/social (not harmful to self or others) legal (doesn't violate laws) phylogenetic (mammals do it)
Phases of the Sexual Response Cycle
Phase 1: desire and excitement/arousal; pulse and RR increase, blood flow to genitals
Phase 2: plateau
Phase 3: orgasm
Phase 4: resolution
How does WHO define being sexually health?
A state of well-being Positive and respectful Pleasurable Consensual Respectful of human rights
Refractory period of sexual response cycle
window of time after orgasm where a man cannot experience another orgasm
Most likely cause of lack of sexual desire
psychosocial issues
Indications to check testosterone level
fatigue, depression, libido, erectile dysfunction
Nervous system control of erection
Parasympathetic
Sacral nerve roots S2-S4
*P=point
Nervous system control of ejaculation
Primarily sympathetic
T10-L2
2 parts: seminal emission, then projectile ejaculation (pudendal nerve, skeletal muscle)
*S=shoot
Define impotence
unable to attain or maintain a penile erection
3 etiologies of erectile dysfunction
organic
psychogenic
mixed etiologies
Psychological contributors to ED
performance anxiety
strained relationship
depression
neurogenic disorders associated with ED
Brain lesions - Dementias, Parkinson’s, stroke, etc.
Peripheral neuropathy
Diabetes mellitus
Chronic alcohol abuse, or vitamin deficiency may affect nerve endings
Meds that induce erectile dysfunction
**SSRI, beta blockers, H2 blockers, antihistamines, opiates
Effects of alcohol on erection
Small amounts improves erection and increases libido (vasodilatory, Suppression of anxiety)
Large amounts can cause central sedation (Decreased libido, transient ED)
Chronic alcoholism (Hypogonadism, Polyneuropathy)
Lifestyle changes to treat ED
Regular exercise
Healthy diet
Smoking cessation
Limiting use of alcohol
How should meds be changed to decrease erectile dysfunction?
chnage beta blockers to alpha antagonists, CCBs, or ACE
change SSRI to bupropion (wellbutrin) or buspirone (Buspar); can also have drug holiday or reduce dose
1st line treatment for ED worldwide
Oral PDE-5Is = phosphodiesterase inhibitors
Sildenafil (Viagra), vardenafil (Levitra) tadalafil (Cialis)
Transurethral therapy for ED
Alprostadil (Synthetic prostaglandin E-1)
Absorption from the urethra to the corpus spongiosum and then corpus cavernosum
MOA of intracavernous injection for ED
Papaverine and Alprostadil
relax cavernous smooth muscle and vessels
How is long-distance cycling a risk factor for ED?
perineal compression on penile arteries
Surgeries for ED
penile pump implant
Primary care approach to ED treatment
- oral PDE-5I if not contraindicated (Viagra, Levitra)
- Consider Transurethral therapy (Alprostadil=MUSE)
- Offer referral for penile pump or injection
- Surgery referral for select patients
Contraindications for prescribing Viagra?
nitrates
Treatment of premature or rapid ejaculation
Behavioral therapy
SSRI
Reduce penile sensitivity with condom or topical anesthetizing cream
Retrograde ejaculation
back flow of semen into bladder during ejaculation
Causes of retrograde ejaculation
common after TURP
alpha-blockers used for BPH
Treatment of retrograde ejaculation
Alpha-sympathomimetics (pseudophedrine)
Elimination of alpha-blockers
What causes delayed orgasm?
most commonly SSRIs
also opiates
Pathophysiology behind ED
- overinhibition of spinal erection center by the brain
- inadequate NO release
- sympathetic overactivity
PDE-5Is do not work if patient does not experience what?
sexual stimulation and NO release into tissues
3 categories of preventative services
Primary
- reduce risk of getting a dz
- Immunizations, Diet & Exercise, Tobacco & Alcohol, Safety, etc…
Secondary
- early dz detection
- DRE, FOBT, Colonoscopy, etc…
Tertiary
- limiting impact of a dz once already present
- Meds, Surgery, Rad/Chemo, etc…
How is the life expectancy of men different than women?
6 years less than women
higher death rates for each of 10 leading causes of death
CDC leading causes of death in men in U.S?
- Heart Disease
- Cancer
- Unintentional injury
- COPD
Screening recommendations for cardiovascular disease risk assessment?
Patients ≥ 20 yo should have CV risk assessment (Framingham risk score) done every 3-5 years
How to screen for obesity, diet, and physical activity?
BMI
Diet/Exercise log
Screening recommendations of USPSTF for diabetes
Who? All adults with HTN and hyperlipidemia
When? every 3 years, more freq if increased risk factors
How? fasting plasma glucose preferred; A1c acceptable
Who should be rx’d aspirin based on his cardiovascular screening?
All adults with a 5-year risk ≥ 3% for CV dz
ASA (81-325 mg/d) daily
Easiest way to prevent cancer
discuss tobacco cessation at each visit
Methods to help with smoking cessation?
Chantix, Bupropion, nicotine patch
Smoking cessation programs
________ is leading cause of cancer-related death among men.
lung cancer
What tests are done to screen for cardiovascular disease?
Framingham risk score BP Total cholesterol and HDL BMI Fasting plasma glucose
Who gets screened for colorectal cancer? how often?
all adults >= 50
stop when 75 or < 10 yr life expectancy
annual fecal occult blood testing
colonoscopy q 10 yrs (5 yrs if increased risk)
Who gets screened for prostate cancer? how often?
Average-risk men: 50yo
High-risk men: 40-45yo (Fam Hx, Black)
Stop screening at age 70
PSA and DRE(?) every 2-4 yrs
Cancers to screen for in men
Colorectal
Prostate
Testicular (controversy)
Melanoma
When and who to screen for chlamydia and gonorrhea?
annual screening in high risk groups, including all sexually active women <25 years
CAGE questionaire
used to screen for alcoholism
Who and how to screen for AAA?
males 65-75 yo who smoke(d) or have 1st degree relative who smokes
get abdominal US just 1 time
How to assess for fall and bone fracture risk?
“get up & go” test
bone mineral density to check for osteopenia/porosis
