Women and Sexuality Flashcards
1
Q
Factors affecting sexuality in adolescence
A
- Puberty changes/Body Image
- Normalizing body fxn/sexual response/needs
- Gender ID and sexual orientation
- Developing sexual value system
2
Q
Factors affecting sexuality in early adulthood
A
- Intimacy development
- Childbearing choices
3
Q
Factors affecting sexuality in midlife
A
- Physiological changes associated with menopause
- Sometimes increased desire
- No worry about pregnancy
- Loss of youth vs increased freedom
- Most no change
4
Q
Phys. changes associated with menopause
A
- Fluctuations in estrogen
- Vasomotor instability
- Irritability
- Fatigue
- Decreased vaginal lubrication
5
Q
Factors affecting sexuality in older women
A
- Continued need for intimacy and desire
- Body and societal image
- Physiological changes - less estrogen, thinning of vaginal tissue, vascular changes
6
Q
Factors affecting sexuality in Pregnancy
A
- First trimester = N/V, fear of losing baby, fatigue, breast pain
- Second trimester - Desire may increase, body changes
- Third Trimester - Discomfort, harming fetus, preterm labor
7
Q
Physiology of Sexual Response
A
- Brain rxn to stimulation
- Change in vascular blood flow
- Estrogen, androgen and progesterone stimulate receptors in hypothalamus
- Estrogen increases –> increased blood flow to periphery and increased nerve transmission
- Oxytocin and endorphins in brain
- Estrogen/Androgens increase vaginal blood flow (Progesterone can diminish)
- Testrosterone increases availability of estrogen
8
Q
4 steps of Masters and Johnson
A
- Excitement
- Plateau
- Orgasmic
- Resolution
9
Q
4 Steps of Circular Model
A
- Seduction (Desire)
- Sensations (Excitement and Plateau)
- Surrender (Orgasm)
- Refraction (Resolution)
- Developed by Whipple
- Works with M&K
10
Q
Non-Linear Model of Female Sexual Response
A
- Includes both physical and emotional components
- Includes both seeking out sexual stimulation and spontaneous sexual desire
11
Q
Low Desire Health Related Factors
A
Chronic Illness
Disability
Chemical Dependency
Medications
12
Q
Medications related to low desire
A
- Anti cancer drugs
- Anti HTN
- Psychotropics
- Amphetamines
- Anticonvulsants
- Antipsychotics (inhibit dopamine)
- Antiulcer
- Narcotics
- Lipid lowering
- GnRH agonists
- OCs
- Hormone Therapy
13
Q
Labs to consider with low desire
A
- Thyroid Function
- Sex hormone binding globulin
- Testosterone (Androgen deficiency)
- Estradiol and FSH (Ovarian fxn)
14
Q
Hypoactive sexual desire (Define)
A
- Persistent/Recurrent
- Deficiency in sexual fantasies, thoughts, desire for sexual activity
- Causes personal distress
15
Q
Causes of Hypoactive sexual desire
A
- Life stressors
- Partner issues
- Control issues
- Physical issues
- Androgen deficiency (some prescribe testosterone)
16
Q
Management of Hypoactive sexual disorder
A
- Treat medical conditions
- Alter medications (SSRIs)
- Therapy for depression
- Address relationship issues
- Address life stressors
- Develop a plan for menopause sxs (vaginal topical estrogen)
- Androgen therapy
17
Q
Androgen therapy
A
- Endogenous androgen levels do not predict sexual fxn
- Therapy increasing serum concentrations to upper limit of normal may improve sexual fxn in premenopausal women
- 1% testosterone cream 0.5 g daily to arms, leg, abdomen
- 300 mcg patch applied twice weekly
18
Q
Side effects of Androgen
A
- Hirsutism
- HDL declines
- Metabolized into estrogen –> AUB, breast pain
19
Q
Sexual Aversion define
A
- Phobic aversion and avoidance of sexual contact that causes personal distress
- Related to hx of sexual abuse
- Ass. with depression, substance abuse, eating disorder
20
Q
Sexual Aversion Management
A
-Referral to therapy
21
Q
Sexual Arousal Disorder
A
-Inability to attain or maintain sufficient excitement/arousal (lubrication, swelling) or somatic responses
22
Q
Causes of sexual arousal disorder
A
-Medications, hormonal changes, physiological/psych problems, inadequate stimulation
23
Q
Sexual Arousal Disorder Assessment
A
- Chronic Illness
- Nerve trauma from cycling
- Medications?
24
Q
Sexual Arousal Disorder Management
A
- Lubricant
- Stimulation
- Localized estrogen therapy for menopausal pt
- Clitoral therapy device to improve bloodflow
- Viagra (Sildenafil) effective for pt on SSRIs
- Testosterone gel/cream
- Alternative therapies
25
Alternative therapies for Sexual Arousal Disorder Management
- Ginko
- Yohimbine- African bark. 14 days continuously. ADE - tachycardia, HTN
- L-Arginine-Supplement shown to increase desire and satisfaction
- Zestra- blend of topical oil and extracts that increases desire and arousal
- Alvimil - Blend of herbal supplements, estrogenic components
- Refer to expert
26
Orgasmic disorder define
-Recurrent difficulty, delay, absence of attaining orgasm following sufficient stimulation and arousal
27
Orgasmic disorder Assesment
- Ever had one?
- Sufficient stimulation? (Do you know your anatomy?)
- Inhibition of orgasmic reflex?
28
Causes for inhibition of orgasmic reflex
- Genital Pain
- Psychological
- Neurological
- Vascular
- Medications
29
Orgasmic disorder Management
- Anatomy instruction
- Types of touch
- Use of vibrator
- Partner involvement
30
Causes dyspareunia
- Pain at introitus is vulvar vestibulitis
- Atrophic Vaginitis- Lactating women, peri/menopausal, women on antiestrogens
- Deep pelvic pain
- Episiotomy/Laceration trauma
31
Vulvar vestibulitis
- Rash outside vagina
- Pain on contact with introitus
- Caused by infection like candida
- Contact dermatitis
- Allergy to semen
32
Causes of deep pelvic pain
- Endometriosis
- Adnexal pain from ovarian cysts
- Adnexal adhesions from pelvic survery
33
Management of dyspareunia
- Treat infection
- Remove irritants
- Topical xylocaine gel
- Biofeedback and massage by PT
- Surgical removal or laser of vestibule
- Amitriptyline 150mg
- Neurontin 360mg
- Estrogen
34
Management of vaginal atropy
- Estrogen topically
- Restoration of normal pH and micro flora
- Thickening of epithelium, secretions
- Decrease in vaginal dryness
35
Preparations of Estrogen
- Vagifem - 10mcg tablet inserted daily for 2wk, then biweekly
- Estring - Vaginal ring. 7.5mcg daily for 90days
- Premarin cream 0.625mg, 0.5-2g cream intra-vaginaly biweekly
- Estrace 100mcg 204g cream daily for 1-2 weeks then taper
36
Contraindications of Estrogen therapy
-Estrogen dependent tumors
37
Vaginismus
- Involuntary contractions of vaginal muscles
- Assessment - inability to insert speculum, inability or difficulty with vaginal penetration
- Manage with muscle relaxation, PT and biofeedback
