14: Evaluation and management of sexual dysfunction in men and women Flashcards
(103 cards)
1
Q
What is the multivariate adjusted odds ratio for erectile dysfunction in patients with diabetes mellitus?
A
2.9
2
Q
List the condition associated with a multivariate adjusted odds ratio of 1.6 for erectile dysfunction (Hint: There are three).
A
Hypertension, Benign prostate enlargement, Current cigarette smoking
3
Q
Which condition has the highest multivariate adjusted odds ratio for erectile dysfunction?
A
Antidepressant use with an odds ratio of 9.1
4
Q
What is the multivariate adjusted odds ratio for erectile dysfunction associated with cardiovascular disease?
A
1.1
5
Q
How does hypercholesterolemia influence the odds ratio for erectile dysfunction?
A
It has a multivariate adjusted odds ratio of 1.0.
6
Q
At what odds ratio does benign prostate enlargement contribute to erectile dysfunction?
A
1.6
7
Q
How does having obstructive urinary symptoms influence the odds ratio for erectile dysfunction?
A
It has a multivariate adjusted odds ratio of 2.2.
8
Q
What is the multivariate adjusted odds ratio for erectile dysfunction in individuals with an increased body mass index (>30 kg/m2)?
A
1.5
9
Q
How does physical inactivity contribute to the odds ratio for erectile dysfunction?
A
Physical inactivity has a multivariate adjusted odds ratio of 1.5.
10
Q
How does current cigarette smoking influence the odds of erectile dysfunction?
A
Current cigarette smoking has a multivariate adjusted odds ratio of 1.6.
11
Q
What is the impact of antidepressant use on the odds ratio for erectile dysfunction?
A
Antidepressant use has a multivariate adjusted odds ratio of 9.1.
12
Q
How does the use of antihypertensives affect the odds ratio for erectile dysfunction?
A
Antihypertensive use has a multivariate adjusted odds ratio of 4.0.
13
Q
Which antihypertensive agent is associated with ED at a rate twice as common as placebo?
A
Diuretics.
14
Q
What is the mechanism by which Diuretics potentially cause ED?
A
Unknown.
15
Q
Which antihypertensive agent causes ED due to the inhibition of prejunctional α2-receptor?
A
β-Blocker (nonselective).
16
Q
How does the α1-Blocker impact sexual function?
A
It decreases the rate of ED but may cause an alteration of ejaculation.
17
Q
What is the mechanism by which α1-Blockers can cause an alteration of ejaculation?
A
Failure of sympathetic-induced (1) closure of the internal sphincter and proximal urethra and (2) failure of seminal emission during ejaculation.
18
Q
Which antihypertensive agent leads to ED due to the inhibition of central α2-receptor?
A
α2-Blocker.
19
Q
How do Angiotensin-converting enzyme inhibitors affect sexual function?
A
They possibly reduce ED.
20
Q
How do Angiotensin II receptor blockers affect sexual function?
A
They possibly reduce ED.
21
Q
Which class of drugs includes Thiazide diuretics, General β-blockers, and Angiotensin-converting enzyme inhibitors as substances known to cause erectile dysfunction?
A
Antihypertensives
22
Q
Name the class of drugs that includes Antipsychotics, Antidepressants, and Anxiolytics which are known to cause erectile dysfunction.
A
Psychotropics
23
Q
Which newer anxiolytics are mentioned in the table as potential causes for erectile dysfunction?
A
Bupropion and Buspirone
24
Q
What are the drugs listed under the “Antiandrogen” class that can lead to erectile dysfunction?
A
Androgen receptor antagonists
Luteinizing hormone–releasing hormone agonists
5α-Reductase inhibitors
25
In the context of recreational drugs, which substances are identified as causing erectile dysfunction?
Tobacco and Alcohol (large volume)
26
In the context of priapism, which type is more likely to present with perineal trauma: Ischemic or Nonischemic?
Nonischemic.
27
Which type of priapism is more associated with hematologic abnormalities?
Ischemic.
28
True or False: Recent intracorporal injection can sometimes be a finding in both Ischemic and Nonischemic priapism.
True.
29
In which type of priapism are the corpora cavernosa usually fully rigid?
Ischemic.
30
Which type of priapism often presents with penile pain?
Ischemic.
31
Regarding penile blood gas in the context of priapism, in which type is it more commonly abnormal?
Ischemic.
32
Which type of priapism typically shows increased cavernous inflow on Doppler?
Nonischemic.
33
What is a cause of sexual dysfunction related to the aging man?
Degeneration of penile afferent nerves.
34
Under the 'Psychogenic' category, what is a listed cause of sexual dysfunction?
Inhibited ejaculation.
35
Name the congenital causes of sexual dysfunction.
Müllerian duct cyst
Wolffian duct abnormality
Prune belly syndrome
36
What anatomic causes can lead to sexual dysfunction?
Transurethral resection of prostate
Bladder neck incision
37
List the neurogenic causes of sexual dysfunction.
Diabetic autonomic neuropathy
Multiple sclerosis
Spinal cord injury
Radical prostatectomy
Proctocolectomy
Bilateral sympathectomy
Abdominal aortic aneurysmectomy
Para-aortic lymphadenectomy
38
Which infective causes can lead to sexual dysfunction?
Urethritis
Genitourinary tuberculosis
Schistosomiasis
39
What endocrine disorders can result in sexual dysfunction?
Hypogonadism
Hypothyroidism
40
Which medications and substances are known to cause sexual dysfunction?
α-Methyldopa
Thiazide diuretics
Tricyclic and SSRI antidepressants
Phenothiazine
Alcohol abuse
41
What is the dosing instruction and indication for Dapoxetine in treating Premature Ejaculation (PE)?
Dosing instruction: On demand, 1–3 hours before intercourse.
Indication: Lifelong PE, Acquired PE.
42
How many countries have approved Dapoxetine for the treatment of PE and what's its level of evidence?
Approved in >50 countries.
Level of Evidence: High.
43
What is the dose range and dosing instructions for Paroxetine?
Dose: 10–40 mg.
Dosing instruction: Once daily.
44
Which drugs for treating PE have a daily dosage regimen and are indicated for both lifelong and acquired PE with a high level of evidence?
Paroxetine, Sertraline, Fluoxetine, Citalopram, Clomipramine (12.5–50 μg).
45
For which drug used in PE treatment is there a potential risk of opiate addiction and what's its level of evidence?
Drug: Tramadol.
Level of Evidence: Low.
46
What are the dosing instructions and comments related to the use of Alprostadil in treating PE?
Patient administered intracavernosal injection 5 minutes before intercourse.
Comments: Risk of priapism and corporal fibrosis.
47
List the PDE5 inhibitors mentioned for PE treatment and their dosing instructions.
Sildenafil 25–100 mg, Tadalafil 10–20 mg, Vardenafil 10–20 mg, Avanafil 50–200 mg.
Dosing instructions: On demand, 30–50 minutes before intercourse.
48
What is the level of evidence for PDE5 inhibitors in treating Lifelong and acquired PE in men with normal erectile function?
Level of Evidence: Low.
49
For men with ED, what is the added benefit of PDE5 inhibitors in treating PE?
Improved efficacy if combined with SSRI.
50
Which drug is titrated by the patient and applied 20–30 minutes before intercourse for treating PE?
Topical lignocaine/prilocaine.
51
What is the mechanism of action for Electromotive drug administration in treating Peyronie Disease?
Bypasses hepatic metabolism, increases concentration of drug to target tissues compared with topical application alone.
52
How do study outcomes differ between Verapamil alone and Verapamil combined with dexamethasone in Peyronie Disease treatment?
Verapamil alone shows no benefit, while Verapamil combined with dexamethasone results in decreases in plaque volume and penile curvature from 43 to 21 degrees.
53
What are the adverse effects of Electromotive drug administration for Peyronie Disease?
Temporary erythema at the electrode site.
54
Describe the mechanism of action for Extracorporeal shock wave therapy in Peyronie Disease.
It causes direct damage to the penile plaque; increases vascularity of the targeted area, inducing an inflammatory reaction, resulting in lysis of the plaque and removal by macrophages.
55
What outcomes can be expected from Extracorporeal shock wave therapy for Peyronie Disease?
Improvements in pain, IIEF-5 score, and mean QoL score; no curvature reduction.
56
What are the potential adverse effects of Extracorporeal shock wave therapy?
Local petechiae and ecchymoses.
57
What's the mechanism of action for Penile traction in treating Peyronie Disease?
It decreases α-smooth muscle actin; increases matrix metalloproteinases involved in collagen degradation.
58
Describe the outcomes observed with Penile traction therapy.
Length increase of 0.5–2.0 cm; girth increase of 0.5–1.0 cm; curvature mean decrease of 20 degrees; pain decrease; softening or shrinking of plaque; overall satisfaction, 85%.
59
: Adverse effects of Penile traction?
Erythema in the balanopreputial sulcus, discomfort.
60
What is the speculated mechanism of action for Vacuum therapy in Peyronie Disease treatment?
Unknown; mechanical effects similar to traction have been suggested.
61
Detail the outcomes achieved through Vacuum therapy for Peyronie Disease.
Reduction in angle of curvature by 5–25 degrees in 21 of 31 patients.
62
What are the adverse effects linked to Vacuum therapy?
Development of PD, urethral bleeding, skin necrosis, and penile ecchymosis.
63
Explain the mechanism of action of Radiation therapy in treating Peyronie Disease.
Antiinflammatory effects via functional modulation of the adhesion of white blood cells to activated endothelial cells and modulation of the induction of nitric oxide synthase in activated macrophages.
64
What is the study outcome of Radiation therapy for Peyronie Disease?
No clinical benefit.
65
Detail the adverse effects associated with Radiation therapy for Peyronie Disease.
Possible malignant change, increased risk for ED in older patients.
66
Under DSM-IV-TR, which disorder is defined as "Deficiency or absence of sexual fantasies and desire for sexual activity"?
Hypoactive sexual desire disorder
67
Under DSM-IV-TR, what defines the "Sexual aversion disorder"?
Aversion to and active avoidance of genital sexual contact with a sexual partner.
68
What is the DSM-5 equivalent for the DSM-IV-TR's Sexual Desire Disorders?
Female Sexual Interest or Arousal Disorder.
69
List all six manifestations of the DSM-5's "Female Sexual Interest or Arousal Disorder".
Absent or reduced interest in sexual activity.
Absent or reduced sexual or erotic thoughts or fantasies.
No or reduced initiation of sexual activity and unreceptive to partner’s attempts to initiate.
Absent or reduced sexual excitement or pleasure during sexual activity in almost all or all (75%–100%) sexual encounters.
Absent or reduced sexual interest or arousal in response to any internal or external sexual or erotic cues (written, verbal, or visual).
Absent or reduced genital or nongenital sensations during sexual activity in almost all or all (75%–100%) sexual encounters.
70
How does DSM-IV-TR define "Female sexual arousal disorder"?
Persistent or recurrent inability to attain or to maintain until completion of the sexual activity, an adequate lubrication-swelling response, or sexual excitement.
71
Under the DSM-IV-TR, define "Female orgasmic disorder".
Persistent or recurrent delay in, or absence of, orgasm after normal sexual excitement.
72
According to DSM-5's "Female Orgasmic Disorder", what are the two occasions of sexual activity mentioned?
Marked delay in, marked infrequency of, or absence of orgasm.
Markedly reduced intensity of orgasmic sensations
73
Define "Dyspareunia" under the DSM-IV-TR.
Genital pain that is associated with sexual intercourse.
74
What is "Vaginismus" according to the DSM-IV-TR?
Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with a penis, finger, tampon, or speculum is attempted.
75
Under DSM-5, what does "Genitopelvic Pain or Penetration Disorder" entail?
Persistent or recurrent difficulties with one or more of the following:
Vaginal penetration during intercourse.
Marked vulvovaginal or pelvic pain during intercourse or penetration attempts.
Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or because of vaginal penetration.
Marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration.
76
Which medical condition may impact female sexual function due to effects on pelvic perfusion, leading to arousal disorder?
Coronary artery disease
77
Lichen sclerosus, lichen planus, and eczema are types of what kind of conditions that can lead to genital pain and problems with lubrication in females?
Dermatologic conditions
78
Which medical condition can result in low desire as a possible impact on female sexual function?
Diabetes mellitus
79
Another medical condition that leads to low desire in females is?
Hypertension
80
A condition that may cause problems with lubrication and orgasm due to hormonal imbalances in females is?
Hypothyroidism
81
Which treatments for malignancy can affect female sexual function across desire, arousal, orgasm, and genital pain?
Treatments for breast, anal, colorectal, bladder, and gynecologic malignancies.
82
Neuromuscular disorders can have an impact on which domains of female sexual function?
Problems with desire, arousal, orgasm, and genital pain.
83
A neurological condition that can lead to low desire in females is?
Parkinson disease
84
Which condition can cause cognitive impairment and results in low desire in women?
Dementia
85
What urinary condition can affect the desire, arousal, and pain domains of female sexual function?
Urinary incontinence
86
Which class of medications does Carbamazepine belong to in relation to its potential association with low sexual desire?
Anticonvulsants
87
List all the Anticonvulsant medications that might be associated with low sexual desire.
Carbamazepine, Phenytoin, Primidone
88
Which cardiovascular medications might be linked to low sexual desire?
Angiotensin-converting enzyme inhibitors, Amiodarone, β-blockers (atenolol, metoprolol, propranolol), Calcium channel blockers, Clonidine, Digoxin, Diuretics (hydrochlorothiazide, spironolactone), Lipid-lowering agents
89
Which hormones are associated with low sexual desire?
Antiandrogens (flutamide), Gonadotropin-releasing hormone agonists, Oral contraceptives
90
What analgesics might lead to low sexual desire?
Nonsteroidal anti-inflammatory drugs, Opiates
91
List the psychotropic medications that can be linked to low sexual desire.
Antipsychotics, Anxiolytics (alprazolam, diazepam), Selective serotonin reuptake inhibitors, Serotonin norepinephrine reuptake inhibitors, Tricyclic antidepressants
92
Which illicit drugs might be associated with reduced sexual desire?
Amphetamine, Cocaine, Heroin, Marijuana
93
What are the other medications or substances (not fitting in the mentioned classes) that might be related to low sexual desire?
Histamine receptor antagonists, Alcohol, Indomethacin, Ketoconazole, Chemotherapeutic agents
94
According to the Biopsychosocial Model in Campbell's Urology, name one of the biological factors affecting sexual (dys)function.
Medications
95
Under which category in the Biopsychosocial Model would you place "Hormonal status"?
Biologic factors
96
Name a psychological factor from the Biopsychosocial Model that can influence sexual function.
Depression
97
Which factor from the Biopsychosocial Model concerns one's own perception of themselves, particularly regarding their appearance or worth?
Self-image
98
Under the category of Sociocultural factors, what is one influence that can stem from an individual's early life and familial environment?
Upbringing
99
In what category of the Biopsychosocial Model would you find "Interpersonal factors" like "Life stressors"?
Interpersonal factors
100
Which sociocultural factor in the Biopsychosocial Model can often have strict guidelines or beliefs about sexual conduct?
Religious influences
101
Under the Biologic factors, which one specifically concerns the study of nerve cells and the networks they form?
Neurobiology
102
If examining the influence of "Partner’s sexual function" on an individual, which category from the Biopsychosocial Model should you refer to?
Interpersonal factors
103
Name all the categories present in the Biopsychosocial Model of Assessing Sexual (Dys)Function from Campbell's Urology.
Biologic factors, Psychological factors, Sociocultural factors, Interpersonal factors
