Treatment of Male/Female Sex Dysfunction Flashcards
3 components of male sexual dysfunction
loss of libido, impotence, ejaculatory failure
neural control of male sexual function
forebrain limbic system + circulating androgens
failure to attain an erection of sufficient strength to carry out sexual intercourse 25% of hte time
impotence
Central erection sequence involves wbhat effects on ps/sympathetic system
increase in ps and inhibition of sympathetic
local parasympathetic reflex arc
penis-spinal cord-penis
Relaxation of the ____ arteries and the smooth muscle of the ____ in the _____ increase penile blood flow
helicine arteries and smooth muscel of trabeculae of corpus cavernosa
T/F venous drainage from penis is impeded by compression by engorged corpora cavernosa
T
___ efferents are involved in ejaculation
sacral efferents
Changes in blood flow during erection are mediated by release of ___ from post synaptic ps neurons and endothelial cells
nitrous oxide
Readily diffusible NO stimulates ___ in the trabecular and arterial smooth muscle cells increasing their content of ____ which in turn relaxes the cells
guanylate cyclase –> cyclic GMP
Dx of erectile dysfunction
exclusion, pt complaint, bulbocavernosus reflex test, npt testing, intracorporeal injection of vasodilators, ultrasound or MRA
T/F tumescence correlates with REM sleep
T –>16-20 times
Tx of male sexual dysfunction
counseling, surgery,iatrogenic drug adjustment, testosterone, vacuum, penile implants, vasodilators
Vasodilators for erectile dysfunction
papaverine, PGE1 analog alprostadil, suppository of alprostadil, oral PDE5 inhibitors (viagra)
PDE5 inhibitors
cgmp phosphodiesterase inhibitors act by inhibiting breakdown of cGMP by PDE –> maintains vasodilatory response
PDE5I are metabolised by ____ to an active/inactive metabolite
CYP3A4 to active metabolite
T/F PDE5I have quick action
T
Side effect of PDE5I
sperm motility, vaginal smooth muscle, esophageal motility, color vision in retina, inhibition of platelet aggregation, vasodilation of other vascular beds
PDE5I should not be taken within 5 hours of taking a ____
nitrate
APA definition of female sexual dysfunction
lack of arousal, pain, and anorgasmia
T/F female sexual dysfunction has greater prevalence among postmenopausal women
t
3 etiological theories of female sexual dysfunction
vascular, hormone, and dissatisfaction theories
Tx of female sexual dysfunction
educational, ERT, PDE5I (only works on those with SSRI induced dysfunction), eros therapy, topical tx
