Urogenital Health Flashcards
Cystitis
A synonym for a lower UTI, although technically it means inflammation of the bladder. It is one of the most common infections in women secondary only to RTI.
Cystitis in adults can cause
- Pain, burning or stinging on urination
- Needing to urinate more often and urgently than usual
- Urine that’s dark, cloudy or strong smelling
Pain low down in the abdomen
cystitis risk factors
- History of previous episodes of cystitis
Frequent/recent sexual activity
cystitis referral
- Nausea
- Vomiting
- Fever
- High back pain
- Children- may be a sign of structural urinary tract abnormality
- Men
If symptoms don’t clear in 3 days
Erectile Dysfunction
The persistent inability to attain and maintain an erectile sufficient to permit satisfactory sexual performance
Erectile dysfunction may be attributable to several different causes including vascular (e.g. peripheral arterial disease, hyperlipidaemia), neuronal (e.g. multiple sclerosis, Parkinson’s Disease), anatomical (e.g. prostate cancer), endocrine (e.g. hypogonadism), psychological (e.g. relationship issues, stress, depression) or it may be drug induced (e.g. antihypertensives, hormonal treatments, recreational drugs)
Very common- prevalence in men aged between 40 and 70 yrs old is 52% with the prevalence increasing with increase in age.
Erection mode of action
During sexual stimulation, nitric oxide is released in the corpus cavernosum (part of the expandable erectile tissue which fills with blood during an erection). Nitric oxide activates an enzyme which converts guanosine triphosphate (GTP) into cyclic guanosine monophosphate (cGMP) which causes smooth muscle relaxation, resulting in an inflow of blood and producing an erection.
cGMP is then broken down by the enzyme phosphodiesterase type 5 (PDE5). Sildenafil is a PDE5 inhibitor and it works by slowing down the degradation of cGMP, resulting in increased blood flow to the penis. Sildenafil only produces an effect in combination with sexual stimulation because it requires the release of nitric oxide in response to sexual stimulation to activate this pathway48.
sildenafil counselling
Sildenafil 50mg tabs is available to purchase from pharmacies as a P medicine aged 18+
One 50mg tablet should be taken approximately 1 hour prior to sexual intercourse. Sildenafil starts to work within approximately 30 mins, although the onset of activity may be delayed if it has been taken with food and has a duration of action of 4 to 5 hrs. it should not be taken more frequently than once daily.
Sildenafil cautions and contraindications
- Hepatic impairment
- Severe renal impairment
- Hypotension (<90/50 mmHg)
- Anatomical deformation of the penis or sickle cell anaemia, multiple myeloma or leukaemia
- Bleeding issues or stomach ulcers
- Cardiovascular issues including stroke, MI within the previous 6 months or uncontrolled hypertension
A mans general fitness for sexual intercourse should also be discussed during the consultation e.g. by asking if becomes short of breath or develops any chest pain on physical exertion
Sildenafil Side effects
- Headache
- Flushing
- Dyspepsia
- Nasal congestion
- Dizziness
- Nausea
- Visual disturbance
- Visual colour distortions
- Blurred vision
Priapism- prolonged or painful erection
sildenafil interactions
The use of sildenafil is contra-indicated with concomitant use of medicines containing nitrates, nitric oxide donors and ritonavir47. See below for further information:
* Medicines containing nitrates (e.g. glyceryl trinitrate, isosorbide mononitrate) or nitric oxide donors (e.g. nicorandil). This combination may result in a dangerous fall in blood pressure. This also applies to some recreational drugs known as poppers (amyl nitrate).
* Ritonavir – this is a potent CYP3A4 inhibitor and inhibits the degradation of sildenafil.
Men taking the following medications should be referred to their GP for further advice47:
* CYP3A4 inhibitors (e.g. itraconazole, ketoconazole, erythromycin, rifampicin, diltiazem)
* Alpha-blockers (e.g. alfuzosin, doxazosin, tamsulosin) – these patients should be referred to their GP as a lower dose of sildenafil may be more appropriate, which is only available on prescription.
* Sacubitril/valsartan – increased risk of hypotension; refer to GP for advice.
Sildenafil should not be taken with grapefruit or grapefruit juice.
25% of cases of erectile dysfunction are caused by medication
Thiazide diuretics, loop diuretics, beta blockers, antidepressants, anticholinergics, antihistamines, parkinsons disease treatments
health promotion advice sildenafil
Pharmacists can use the sildenafil consultation to provide health promotion advice by responding sensitively with advice on lifestyle modifications that reduce the risk of erectile dysfunction. This advice reflects general health advice for reducing overall cardiovascular risk47,50 such as the importance of:
* maintaining a healthy diet and weight
* regular exercise
* reducing stress
* smoking cessation
* moderating alcohol consumption
avoiding recreational drugs
Vaginal Atrophy
A condition associated with the menopause in which the vaginal walls become thin, dry and inflamed. During the menopause, the ovaries produce less oestrogen, resulting in thinning of the mucosal cells, reduced elasticity of the vagina and reduced mucus production. The symptoms of vaginal atrophy include vaginal dryness, soreness, itching, burning and painful sexual intercourse. Women may also experience urinary symptoms of frequency, nocturia, urgency, dysuria and more frequent UTIs. It is a chronic and progressive condition which affects approx 50% of post menopausal women.
NICE recommends that low dose vaginal oestrogen should be offered first line to women with urogenital symptoms and continued for as long as necessary. Gina (vaginal oestrogen tablet) available to purchase OTC in the UK.
vaginal atrophy moa
Vaginal oestrogen therapy delivers oestrogen directly to the vaginal tissue, increasing maturation of the vaginal epithelial cells, promoting natural flora and lubrication, and restoring the vaginal pH, which helps to relieve the symptoms of vaginal atrophy. Very low levels of oestrogen are absorbed into the bloodstream, and vaginal oestrogen therapy only treats the local symptoms of vaginal atrophy. And does not treat vasomotor menopausal symptoms such as hot flushes and night sweats
vaginal atrophy health promotion advice
- Cervical screening
- Breast screening
- Breast self checking
- Weight bearing exercise
- A healthy diet
- Sunlight
Calcium/vitamin D
vaginal atrophy treatment
Vaginal oestrogen therapy is indicated for the treatment of vaginal atrophy due to oestrogen deficiency in post menopausal women aged 50 years and above, who have not had a period for atleast 1 year
It can be used in women with or without an intact uterus
Vaginal oestrogen tablets can be used alongside vaginal moisturisers or lubricants
For the first 2 weeks of treatment, one vaginal tablet is inserted once daily into the vagina using the pre loaded applicator
After the initial 2 weeks of treatment, the dose is reduced to one vaginal tablet administered twice weekly, which is the maintenance dose
During the maintenance dose, the woman should pick 2 days a week to administer the vaginal tablets, leaving 3 or 4 days between each dose
