SEXUALITY AND MEN'S HEALTH Flashcards by BIJAY KENT HIRATA

Vehicle to demonstrate attraction, intimacy and
commitment

Sexuality

How well did you know this?

Not at all

Perfectly

Sexuality is a major priority to ____ patients

SCI, (vs. return of
sensation, ability to walk, N bowel and bladder
function)

How well did you know this?

Not at all

Perfectly

salvaging and restoring
remaining function AND remaking and readjusting

Sexual rehabilitation

How well did you know this?

Not at all

Perfectly

Who invented the 4-phase model of sexual function

Masters and Johnsons’ (1996)

How well did you know this?

Not at all

Perfectly

What is the four-phase model

Excitement
Plateau (high arousal before orgasm)
Orgasm
Resolution (reversal/ dissipation of
phase 1)

How well did you know this?

Not at all

Perfectly

EXCITEMENT:

-Tumescence/Erection of erectile tissues
-vaginal lubrication & accommodation
(lengthening & uterine lifting)
-⬆️CV and respiration parameters
-(+)sweating

How well did you know this?

Not at all

Perfectly

PLATAEU:

M: Maximal erection & rigidity,
approaches ejaculatory inevitability
F: outer third of vagina forms a
thickening (orgasmic platform)

How well did you know this?

Not at all

Perfectly

ORGASMIC PHASE:

-Maximal HR, BP, and RR (in healthy
individuals)
- (+) ejaculation

How well did you know this?

Not at all

Perfectly

RESOLUTION

-Gradual reversal of tumescence,
-pelvic vasocongestion,
-neuromuscular tension,
-CV parameters

M:
-additional physiologic refractory period

F:
-extended, repeated, multiple orgasms

How well did you know this?

Not at all

Perfectly

are multifactorial involving physiological,
psychological, social, and emotional
components

Sexual Dysfunction

How well did you know this?

Not at all

Perfectly

Experience of specific sensations
that motivate the individual to
initiate or become responsive to
sexual stimulation

Sexual desire/Libido

How well did you know this?

Not at all

Perfectly

Reduction or change in
sexual drive common
among persons with
disabilities

Hypoactive Sexual Desire disorder

How well did you know this?

Not at all

Perfectly

What is an example of a hypoactive sexual desire disorder?

E.g.
(1) Kluver-Bucy
syndrome;
(2) effect of
medications
(replacement of
Dopamine in PD

How well did you know this?

Not at all

Perfectly

Other sexual disorders (M&J model)

-Arousal disorders
-Ejaculatory dysfunction
-Orgasmic disorders

How well did you know this?

Not at all

Perfectly

Disorders of
male penile
erection

Arousal disorders (AKA erectile dysfunction)

How well did you know this?

Not at all

Perfectly

Problems with
the antegrade
seminal fluid
expulsion

Ejaculatory dysfunction

How well did you know this?

Not at all

Perfectly

Inability to
reach orgasm

Orgasmic disorder

How well did you know this?

Not at all

Perfectly

Problems within these three phases include _______ and
______

fertility issues
dyspareunia

How well did you know this?

Not at all

Perfectly

STUDY PAGE 12

How well did you know this?

Not at all

Perfectly

In women, lubrication
depends on:

-intact innervation
-(N) estrogen levels

How well did you know this?

Not at all

Perfectly

In men, internal accessory
organ functioning
(including semen
production) and erection
are dependent on:

Adequate testosterone level

How well did you know this?

Not at all

Perfectly

2 neurological pathways for genital arousal

Reflexogenic
Psychogenic

How well did you know this?

Not at all

Perfectly

REFLEXOGENIC

Triggered by
direct
stimulation
of genitals

How well did you know this?

Not at all

Perfectly

PSYCHOGENIC

Supraspinal
origin
(auditory,
imaginative,
visual, etc)

How well did you know this?

Not at all

Perfectly

Presence of morning (REM) erections is a sign that daytime erection problems are psychogenic in nature

A. Arousal B. Ejaculation 1.Parasympahetic 2.Sympathetic

A B

Two phases of ejaculation

- seminal emission (symph. T10-L2) - expulsion (parasymph. S2-S4; symph.)

T/F May include orgasmic attainment without genital stimulation

T/F Half of men and women with complete SCI cannot experience orgasm

F, CAN STILL

T/F High androgen levels make orgasm more difficult in men and women

F, Low

T/FDopamine levels rise during arousal and orgasm

F, Oxytocin

T/F Prolactin remain elevated even after orgasm

Disability-related sexual dysfunctions (DRSD)

Direct effects of vascular, neurologic (including pain), hormonal, anatomical, damage to any area functionally connected to sex response

Disability-related sexual dysfunctions

Indirect effect of medical/ psychological condition

Disability-related sexual dysfunctions

Iatrogenic effects of treatment (radiation, surgery, meds, chemo

Disability-related sexual dysfunctions

Contextual factors such as biopsychosocial and situational components

Disability-related sexual dysfunctions

Medications (DA, NA, serotonin)

Drugs that______ affect sexual function

↓ NA

DA blockers _____

↓ libido

DA agonists ________

↑ libido

Effect of serotonin reuptake inhibitors:

↓ libido, orgasmic and ejaculatory delay

Sympathomimetic drugs ______

inhibit genital arousal

T/F Aging = (↓ elasticity of tissues)

T/F More sexual dysfunctions in F vs M

F, more in M

Aging in F

Less vaginal lubrications, ↓ muscle spasm during orgasm, dyspareunia ↓,

AGING IN M

2-3x as long as to achieve erection, erection not as rigid, orgasm delayed, ↓ ejaculatory fluid volume, penile detumescence occur rapidly, refractory period longer (days)

Lost interest and people tend to focus more on survival

Impending mortality (Fatigue, medications, change of body image, altered hormonal status, catheters, secondary paralysis, etc)

Neurological changes

Injuries to the central and peripheral nervous structures

How many years of recovery before remaining neurological sexual function is known

Most acquired neurological damage (2-4 yrs)

Psychological factors

-Depression -Loss of self-esteem -Anxiety (premature ejac./dec orgasmic attainment)

Those with cardiovascular problems: HR: ________bpm peak SBP: ______ mmHg METs do not exceed: ______

110-130 150-170 4-5

METs during sex

-Walking @ treadmill c 3mph @ 5% grade -Climbing 2 flights of stairs (6METs, 20 steps in 10 seconds) -long standing rel.

measure used to determine risk of ischemia or safe return to sexual activities

6 METs

Bladder & Bowel control

-Odor from leakage -Visibility of urine or stool collection devices = ↓ sexual interest and self esteem

Two types of pain issues

1. Pain in genitalia 2. Chronic pain

Patients with chronic pain report sexual difficulties to be ________ that of the general population

Fertility issues

----------

Quantity & Quality of semen

-intravaginal and intrauterine insemination, -in vitro fertilization

Causes why women are unable to participate in sex d/t/ sexual pain disorders:

-Sjogren's syndrome -Severed adductor spasm/spasticity

T/F TBI reduces sperm motility and semen count in men

F, SCI

SCI in W:

- changes in bladder mx - delayed bowel emptying - difficulty in transfers - fatigue - inc risk for DVT - inc risk of UTI d/t pregnancy - pedal edema - skin breakdown - thrombophlebitis - vaginal spotting

Delivery type which are common:

CS sections Vacuum & forceps extractions

T/F Low birthweight infants are also common in pregnant women with SCI

Complete SCI above the LS spinal cord center (above ______):

T10 (+) reflexogenic arousal, (-) psychogenic arousal

Complete lesions interrupting reflexogenic pathways:

reliance on psychogenic arousal

Men with sacral SCI reliant on psychogenic arousal triggers:

-unwanted seminal emission -penile detumescence

This are capable of psychogenic arousal:

SCI with preserved sensation in the T11-L2 level

This indicates intact reflexogenic arousal capacity

Presence of (+) bulbocavernosus reflex

Men with SCI:

90% have ejaculatory disorders

Natural ejaculation most likely to occur to men with:

incomplete conus medullaris or cauda equina lesion

natural ejaculation least likely to occur to men with

complete supraconal lesion

FOR SCI: Orgasm is attainable in _____% of men (with ejaculation & ____% in women

40-45 50

In MS, _____% of M&W experience sexual dysfunction

Multiple Sclerosis cause decreased libio, inability to attain orgasm

- In ambulatory male patients with MS

60% = ED 50% = ejaculatory/orgasmic dysfunction 40% = reduced desire

Women with MS

- 68% unsatisfactory sexual lives d/t fatigue - 48% dec genital sensation - 35% reduced vaginal lubrication - 35% difficulty c arousal - 72% difficulty reaching orgasm, - sexual pain disorders

Limb amputation

-Positioning with pillows or wedges, -side-by-side intercourse are necessary for upper limb or transfemoral amputations

Parkinson's disease

W: - 75% diff with arousal & orgasm - 50% low sexual desire M: - 70% ED, - 40% premature ejaculation, - 40% delayed orgasm

For PD, _____ drugs: increase sexual drive

Dopaminergic

TBI

- Decreased desire and arousal disorders are common - Low energy and interest in initiating sex - Difficulties with erection, vaginal dryness

Stroke

Decrease in : libido, lubrication, erectile capability, frequency of sexual activity

Coronary Artery Disease

75% of middle-aged male patients reported decreased sexual activity 80% with CHF reported inability to engage in sexual activities

Pulmonary disease

Decreased endurance

Type of DM where sexual dysfunction is correlated with depression

Type 1

In DM, ED correlates c

poor glycemic control, onset of retrograde ejaculation, impaired genital sensation

Comorbidities from Chronic Renal Failure (CRF) responsible for ED:

- W: menstrual abnormalities - Both sexes: dec libido and fertility

Hyperprolactinemia

decreased: libido, frequency of sexual intercourse, orgasmic difficulties

STUDY REHABILITATION FRAMEWORK