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GYN > Women and Sexuality > Flashcards

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
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2
Q

Factors affecting sexuality in early adulthood

A
  • Intimacy development

- Childbearing choices

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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
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4
Q

Phys. changes associated with menopause

A
  • Fluctuations in estrogen
  • Vasomotor instability
  • Irritability
  • Fatigue
  • Decreased vaginal lubrication
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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
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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
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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
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8
Q

4 steps of Masters and Johnson

A
  • Excitement
  • Plateau
  • Orgasmic
  • Resolution
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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
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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

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11
Q

Low Desire Health Related Factors

A

Chronic Illness
Disability
Chemical Dependency
Medications

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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
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13
Q

Labs to consider with low desire

A
  • Thyroid Function
  • Sex hormone binding globulin
  • Testosterone (Androgen deficiency)
  • Estradiol and FSH (Ovarian fxn)
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14
Q

Hypoactive sexual desire (Define)

A
  • Persistent/Recurrent
  • Deficiency in sexual fantasies, thoughts, desire for sexual activity
  • Causes personal distress
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15
Q

Causes of Hypoactive sexual desire

A
  • Life stressors
  • Partner issues
  • Control issues
  • Physical issues
  • Androgen deficiency (some prescribe testosterone)
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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
Q

Alternative therapies for Sexual Arousal Disorder Management

A
  • 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
Q

Orgasmic disorder define

A

-Recurrent difficulty, delay, absence of attaining orgasm following sufficient stimulation and arousal

27
Q

Orgasmic disorder Assesment

A
  • Ever had one?
  • Sufficient stimulation? (Do you know your anatomy?)
  • Inhibition of orgasmic reflex?
28
Q

Causes for inhibition of orgasmic reflex

A
  • Genital Pain
  • Psychological
  • Neurological
  • Vascular
  • Medications
29
Q

Orgasmic disorder Management

A
  • Anatomy instruction
  • Types of touch
  • Use of vibrator
  • Partner involvement
30
Q

Causes dyspareunia

A
  • Pain at introitus is vulvar vestibulitis
  • Atrophic Vaginitis- Lactating women, peri/menopausal, women on antiestrogens
  • Deep pelvic pain
  • Episiotomy/Laceration trauma
31
Q

Vulvar vestibulitis

A
  • Rash outside vagina
  • Pain on contact with introitus
  • Caused by infection like candida
  • Contact dermatitis
  • Allergy to semen
32
Q

Causes of deep pelvic pain

A
  • Endometriosis
  • Adnexal pain from ovarian cysts
  • Adnexal adhesions from pelvic survery
33
Q

Management of dyspareunia

A
  • Treat infection
  • Remove irritants
  • Topical xylocaine gel
  • Biofeedback and massage by PT
  • Surgical removal or laser of vestibule
  • Amitriptyline 150mg
  • Neurontin 360mg
  • Estrogen
34
Q

Management of vaginal atropy

A
  • Estrogen topically
  • Restoration of normal pH and micro flora
  • Thickening of epithelium, secretions
  • Decrease in vaginal dryness
35
Q

Preparations of Estrogen

A
  • 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
Q

Contraindications of Estrogen therapy

A

-Estrogen dependent tumors

37
Q

Vaginismus

A
  • Involuntary contractions of vaginal muscles
  • Assessment - inability to insert speculum, inability or difficulty with vaginal penetration
  • Manage with muscle relaxation, PT and biofeedback

GYN (7 decks)

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