Sexuality & Men's Health Flashcards
S3Q1
SEX: Sexuality
what (3)
sexual rehab (2.2)
- vehicle for attraction, intimacy, commitment
- sexual rehab = salvaging & restoring remaining functions, remaking & readjusting
SEX: Models of Sexual Function
who (2)
phase 1 - M&F (2.3), other (3)
phase 2 - M&F (2.1=1)
phase 3 - (3.1+2)
phase 4 - what, M vs. F
- masters & johnson
excitement
- M: tumescence/erection of tissues
- F: lubrication, uterine lifting & lengthening
- inc CV, respiratory, sweating
plateau
- M: maximal erection & rigidity
- F: thickening of outer 3rd vagina = orgasmic platform
orgasm
- ejaculation + pelvic floor, smooth muscle contraction in organs
- maximal BP HR RR
resolution
- reversal
- M = longer refractory, F = multiple orgasm
SEX: Sexual Dysfunction
factors (4)
sexual desire - other term, what, disorder + who + example (2)
other sexual disorders (3) + related to (2)
- factors: psych, social, physio, emotional
sexual desire / libido
- sensation = initiate/respond to sexual stimulation
hypoactive sexual desire disorder
- common in PWD
- ex of hyper: kluver-bucy syndrome (medial temporal lobe; amygdala & hippocampus), changed dopamine in PD
other sexual disorders
- arousal disorder/erectile dysfunction: erection
- ejaculatory dysfunction: should be antegrade seminal expulsion
- orgasmic disorders: can’t reach
- related to fertility issues & dyspareunia (difficult or painful intercourse d/t sjobren’s)
SEX: Neurophysiology
4 –> 2 –> 1.2.1 –> 1
functions
cerebrum, midbrain, limbic system, hypothalamus
(usually inhibitory in day to day)
brainstem & spinal cord
sacral parasympathetic (pelvic nerves)
thoracolumbar sympathetic (hypogastric & lumbar)
somatic nerves (pudendal)
pelvic floor
SEX: Neurophysiology
women - what depends on (2)
men - (2) depends on what
pathways - by, by + form (3) + presence of what indicates what
arousal vs. ejaculation - innervation (1) (1.2)
orgasm - dependent on, inc (2)
- F: lubrication depends on innervation & estrogen
- M: organ function (semen production) & erection depends on testosterone
pathways
- reflexogenic: by direct genital stimulation
- psychogenic: supraspinal origin (visual imaginative auditory); morning (REM) erection = daytime erection problem is psych
arousal
- parasympathetic
ejaculation
- seminal emission: sympathetic T10-L2
- expulsion: parasympathetic S2-S4, symp
orgasm
- low androgen = more difficult
- inc oxytocin & prolactin (remain high)
SEX: Disability
direct effect of (3), indirect (2), iatrogenic (4)
factors (2)
- direct: anatomical, hormonal, neurological, vascular
- indirect: meds, psych condition
- iatrogenic: tx (radiation, chemo, surgery, meds)
- factors: biopsychosocial, situational
SEX: Disability
medication - 1.1.3.1
impending mortality - (6)
CV - HR, SBP, METs, how many METs = determine (2)
MEDICATION
- dec noradrenaline = affect sex
- DA blocker = less libido
- serotonic uptake inhibitor = less libido, orgasm & ejaculatory delay
- sympathetic drug = dec arousal
IMPENDING MORTALITY
- fatigue, meds, catether, secondary paralysis, body image, hormone
CV
- HR: 110-130 bpm, SBP: 150-170, METS: <4-5
- 6 METs = determine risk of ischemia or safe to return
SEX: Disability
aging - d/t, sex, M&F (6.3)
- d/t tissue elasticity
- M>F
men
- dec rigidity, dec fluid volume
- delayed erection, delayed orgasm
- detumescence rapidly, longer refractory (days)
women
- dec lubrication, dec orgasm muscle spasm
- dyspareunia
SEX: Disability
neurological - d/t (2), prognosis
psychological - (3) = (2)
bladder - (3=1)
pain
psych: SAD
NEUROLOGICAL
- damage to CNS & PNS
- need 2-4y recovery before determine remaining sexual function
PSYCHOLOGICAL
- depression, self-esteem, anxiety (= premature ejaculation or can’t orgam)
BLADDER & BOWEL
- visibility of stool or urine, odor, leakage = dec libido
CHRONIC PAIN
SEX: Disability
fertility - men (2=2), women d/t (2) + birth (3)
limb - if (2) = (2)
coronary artery disease
pulmonary - (1)
FERTILITY ISSUES
- M: quantity & quality of semen (IVF, insemination)
- women unable to sex d/t pain disorders (sjogren’s = dec mucus, severe ADD spasm in CP)
- usually CS, vacuum or forceps extraction
LIMB
- if upper limb or transfemoral = pillow & wegde, side to side intercourse
CAD
PULMONARY
- endurance
SEX: Disability
MS - men (3), women (6=1)
PD - men (3), women (3)
TBI & stroke - (2=1)
TBI: no output
MS
- M: ED, orgasm/ejaculation, dec libido
- F: unsatisfied d/t pain disorder, fatigue, dec lubrication, diff arousal, diff orgasm, dec genital sensation (d/t reflexogenic)
PD
- M: ED, premature ejaculation, delayed orgasm
- F: diff arousal, diff orgasm, dec libido
TBI/STROKE
- dec libido, ED, dry vagina
SEX: Disability
DM - ED d/t (3), if type x then dysfunction d/t what
CRF - comorbidities lead to (4), prolactin = (3)
DM
- ED d/t poor glycemic control, dec genital (reflexogenic), retrograde ejaculation
- type I = dysfunction d/t depression
CHRONIC RENAL FAILURE
- comorbidities = mens, fertility, dec libido, ED
- hyperprolactin = infrequent, diff orgasm, dec libido
SEX: Disability - SCI
if complete SCI above x center which is what levels then what
if men have sacral SCI & rely on psychogenic then what
levels needed to preserve for psychogenic
if x reflex = what
orgasm epidemiology
- if complete SCI above lumbosacral centers (above T10) = rely only on reflexogenic
- if men sacral SCI rely on psych = unwanted ejaculation or quick detumescence
- preserve T11-L2 = psychogenic
- (+) bulbocavernosus reflex = reflexogenic
- 50% of M&F c SCI still orgasm (F>M)
SEX: Disability - SCI
men - dec (2), if (2) = (1), if (1) = (1)
women - (9) + if pregnant then inc risk of (2)
men: sperm, women: spotting
MEN
- dec sperm motility & count
- if incomplete conus or cauda lesion = natural ejaculation
- if complete supraconal lesion = least natural
WOMEN
- vaginal spotting, thromboembolitis, DVT, pedal edema, skin breakdown
- transfers, fatigue
- bladder, diff bowel emptying
- if pregnant = inc UTI, LBW
SEX: Framework
10
- sexual interest
- sexual response
- changes in genital sensation or erogenous zones
- changes in motor function
- bladder & bowel issues
- factors associated c condition
- practical use of contraceptives, concerns about fertility pregnancy delivery
- parenting issues specific to disability
- relationship issues
- sexual self-esteem issues
