Treatment for Sexual Dysfunctions Flashcards
What comprises non-medical treatment?
Psychotherapy and pelvic floor physiotherapy
What comprises medical treatment?
Pharmacological options
Mechanical options
Surgical options
What is sex therapy?
Talk therapy that addresses sexual concerns
What is the difference between sex therapy and sex surrogacy?
Sex surrogacy is hands on and sex therapy is NOT!
What is the PLISSIT model?
A scientific model of which sex therapy and other forms of therapy are based on.
Determines the different levels of intervention for a client
What does the PLISSIT model stand for?
P -> Permission
LI -> Limited information
SS -> Specific suggestion
IT -> Intensive therapy
What does the PLISSIT model mean by “permission”
Reassurance
Permission to engage or not
Permission to feel comfortable
What does the PLISSIT model mean by “limited information”
Provide client with information about specific concern
Sex education
Dispel myths
What does the PLISSIT model mean by “specific suggestions”
Homework exercises
Behavioural exercises
Based on client goals
What are common client goals?
Reduce anxiety
Enhance communication
Enhance arousal
What kind of homework/behavioural exercises can be specifically suggested?
Sensate focus Body exploration Communication skills Pelvic floor exercises Stop-start technique Squeeze technique
What is sensate focus?
- > One of the most useful activities for enhancing sexual enjoyment
- > Cornerstone of sex therapy
- > Can reduce anxiety caused by goal orientation
- > Focusing on sensation rather than performance
- > Expands sexual repertoire by starting at baseline again
- > Basic step for treating all sexual issues
- > Helps couples explore what they like and don’t like through verbal feedback
What are the different stages of sensate focus?
- Non-genital
- Genital sensate focus
- Penetration without movement
- Penetration with movement
What are some suggestions for premature (early) ejaculation (PE)?
- > Ejaculate more frequently
- > Change positions
- > Communicate
- > Alternatives to penetrative activities
What are some suggestions for erectile dysfunction?
- > Talk about performance anxiety
- > Dispel myths (such that sex = intercourse, and that a male is always ready and wants to have sex)
- > Sensate focus
When is intensive therapy suggested?
- When the issue cannot be addressed by other exercises
2. Cases of trauma or psychological comorbidities
What sexual dysfunctions can pelvic floor physiotherapy address?
Most commonly GPPPD (vulvodynia and vaginismus)
Evidence is coming out for PE and ED
It can help most people who don’t really understand what is happening in the core in their body
What are the goals of pelvic floor physiotherapy for GPPPD?
- > Increase awareness of pelvic floor muscles
- > Improve muscle relaxation
- > Increase elasticity at vaginal opening
- > Desensitize painful areas
- > Decrease fear of penetration
What are some pelvic floor physiotherapy techniques for GPPPD?
Manual (massaging, stretching, treats restrictions)
Vaginal dilation exercises (desensitizes and stretches vaginal opening, improve control, reduce fear)
Biofeedback (improves control of muscles)
What are the oral medications used to treat ED?
Viagra, Cialis, Levitra (PDE-5 inhibitors)
What is the first line treatment for ED?
Oral medication
What are the 4 important components of an erection?
- Blood flow
- Neuronal communication
- Sex hormones
- Brain
How does viagra work for ED?
- > Blocks/inhibits the enzyme phosphodiesterase type 5 (PDE-5)
- > Doing so increases blood flow to penis
Can the PDE-5 inhibitors cause an erection without any sexual stimulation?
NO
Need sexual stimulation or sexual arousal
How long does viagra take to work?
About 30 min but possibly longer if ingested after a fatty meal
**Grapefruit juice can interfere with body’s absorption of viagra
How long does viagra last?
There is a potential for an erection within a 4 to 6 hour window
What are some possible side effects of viagra?
- > Headaches
- > UTIs if taken regularly
- > Priapism (prolonged erection)
Combining viagra with _______ can result in a sudden drop of blood pressure which can be fatal
nitrates
What are some problems that can interfere with blood flow to the corpora and might be resulting in ED?
- > Anti-depressants
- > Beta-blockers
- > Diabetes
- > High blood pressure
- > Obesity
- > Alcohol
- > Smoking
What was viagra initially developed for?
High blood pressure/heart disease
How do intracavernosal injections work for ED?
- > Vasodilators injected into penis (left or right corpora cavernous)
- > Relax smooth muscle tissues and increase blood flow
Can intracavernosal injections cause an erection without sexual stimulation?
YEP
What are some potential side effects of intracavernosal injections?
- > Numbness of glands
- > Tissue damage at site of injection
- > Infection
- > Priapism
How does medicated urethral system work for ED?
-> Pellets pushed into urethra with application and massaged in
When do people choose to use medicated urethral system?
As an alternative to injections
What are some potential side effects and issues with medicated urethral system for ED?
- > Top heavy erection
- > Medication is harmful to pregnant women
- > Priapism
Are there any pharmacological approaches for treating PE?
Yes, SSRIs but only in severe cases when behavioural approaches aren’t working
Are there any pharmacological approaches for treating low desire in women?
Yes, Addyi
What is Addyi?
Originally developed as an antidepressant
Acts on neurotransmitters (increases dopamine and norepinephrine and decreases serotonin)
What are some of the issues and controversies with Addyi?
- > Costly
- > Difficult to find someone LICENSED to prescribe it
- > LOTS of side effects
- > Has to be taken everyday and cannot consume alcohol
- > Study has shown it to be no more effective than placebo
Why is Addyi not the “female version” of viagra?
Addyi affects desire whereas viagra affects arousal
What are the main differences between Addyi and viagara?
Addyi:
- Central (brain) effects
- Taken every day
- Affects desire
Viagra:
- Local (peripheral, penile) effects
- Taken as needed
- Affects arousal
What is a mechanical treatment for ED?
Vacuum erection pump
How does a vacuum erection pump work?
- > Chamber is placed over penis
- > Turning on pump draws blood into penis by creating negative pressure
- > Constriction band placed at base of penis to trap blood when chamber is removed
Is a vacuum erection pump effective?
Yes in 50 to 80% of cases but it is fairly costly
What are some issues/ side effects/ draw backs with the vacuum erection pump?
- > If taking blood thinning medication there is an increased risk of bleeding
- > Numbness, bluish cold skin
- > Pain or brusing
- > Pain/discomfort during ejaculation
- > May feel unnatural
- > Top heavy erections
What is a surgical treatment for ED?
Penile protheses
What are the types of penile protheses, how do they work. how do they differ?
Semi-rigid
- Rods are implanted
- Penis is always semi-erect
Inflatable 3 piece system
- Two inflated cylinders in cavernosa
- Pump is in scrotum
- Fluid filled reservoir in abdomen
Inflatable 2 piece system
- Reservoir is located in rear portion of cylinders
- Bending penis returns fluid to reservoir
Why would someone want the inflatable protheses instead of the semi-rigid?
Although the semi-rigid option is more simple to implant the inflatable option allows for more natural looking and acting erections
Why are penile protheses considered a last resort?
Once implanted there is no way to go back
What is a surgical treatment for provoked vestibulodynia (PVD)?
Vulvar vestibulectomy
Some tissue around vaginal opening is removed
What are the controversies of vulvar vestibulectomy for PVD?
One randomized control trial found that pain reduction in penetrative activities was the same in both the surgical and CBT group
Masters and Johnson referred to the focus of monitoring one’s function as ________
spectatoring
What was Masters and Johnson’s major therapy innovation?
Sensate focus
The focus on eliminating sexual symptoms as obstacles to normative sexual functioning has remained a feature of the predominant treatment models but why is this problematic?
It ignores other underlying problems
It is basically only saying that if the symptom can be relived by A than the problem is caused by a lack of A
An example of this is the PDE-5 inhibitors
- these oral medications may cause an erection by fixed physiological problems but it is not addressing other underlying issues that could be at play (i.e., performance anxiety, lack of desire)
