15 - Femal Sexual Response Flashcards Preview

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Flashcards in 15 - Femal Sexual Response Deck (26)
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1
Q

Sexual response cycle?

A
Drive
Arousal
- subconscious
- autonomic nervous system
- subjective  (blood flow and fluids and stuff)
Emotional modulators
2
Q

Pregnancy/postpartum variations of psyiologic sex response?

A
Fatigue
Hormone changes
Breast feeding
- decreases sex satisfaction
Method of delivery
3
Q

Menopause variations on sex response?

A

Hypoestrogenic state

- more to follow in chapter 18

4
Q

Sexual dysfunction stats?

A

64% - low/no sex desire
35% - difficulty w orgasm
26% - sexual pain

Generally last <6 mo

5
Q

Psychiatric sexual dysfunction

A
Painful intercourse
Disturbance in
- desire
- arousal
- orgasm
- resolution
6
Q

Sexual dysfunction types?

DSM-5

A
Female sexual interest/arousal d/o
Female orgasmic d/o
Genitopelvic pain/penetration d/o
Substance/medication-induced sex dysfunction
Other 

Can be

  • lifelong - acquired
  • generalized - situational
7
Q

Psychosocial risk factors for sexual dysfunction?

A
Comorbid psych d/o
Neg emotions
Maladaptive conditions
Cultural factors
Lack of sex ed
Couple distress
Physical attraction
8
Q

Phases of sexual response

A

Desire (libido) - testosterone
Excitement (arousal) - estrogen
Orgasmic - sympathetics

9
Q

Desire (libido) is moderated by?

A

Testosterone

  • excited by dopamine
  • suppressed by serotonin

Hypoactivity - 65% of all sexuality issues

10
Q

Excitement phase is affected by?

A

Modulated by parasympathetics

Enhanced by estrogen

11
Q

Excitement extragenital effects?

A
HR, 
BP 
muscle tension
Breast size
Areolar engorgement
Nipple erection
Sex flush (75%)
12
Q

Most treatable sexual phase d/o?

A

Orgasmic phase

  • its modulated by sympathetics
  • optimized by clitoral input
13
Q

Risk factors for dyspareunia?

A

Age <50:

  • sexual abuse
  • hx of PID
  • Depression
  • anxiety
14
Q

What is vaginismus?

A

Involuntary contraction of outer 1/3 of vaginal muscles

15
Q

Sexual dysfunction w/u?

A

Hx is key
Eval for physical cause
Eval for psych d/o

16
Q

Sex dysfunction tx approach?

A

Multidisciplinary tx team

  • load the boat
  • gyn, psych, nurse-specialist
  • and organic - urology, GI, etc
17
Q

Psychological approaches dysfunction tx?

A

Combo of

  • sex ed
  • communication enhancement
  • ID emotional/cultural factors
  • cognitive-behavior therapy
  • couples therapy
18
Q

Prevalence of domestic violence?

A

ER sampling
54% - lifetime
24% - current partner

19
Q

Sexual assault definition?

A

Any sexual act w/o consent

  • threat/force
  • even includes viewing of porn
20
Q

Sexual assault stats?

A

Incidence

  • 20% under 21 y/o
  • 13-39% lifetime

Perpetrators
- 75% know their victim

Injuries

  • 70% - no obvious inj
  • 24% - minor inj
  • 5% - serious inj

Death is rare but fear of death is common

21
Q

PE for sexual assault?

A
Use SANE if available 
Follow the checklist
Get consent for exam
Chaperone - have one
Law enforcement - notification 
- restricted vs unrestricted reporting
22
Q

Tx for sexual assault

A

Injury tx

STD prophylaxis

  • GC, non GC
  • HBIG/Hep B
  • HIV prophylaxis (dependent on risk)

Emergency contraception

  • pan B
  • anti-emetic
23
Q

Care after sex assault?

A

Mental health/counseling referral

Follow up
- 1 week of prophylaxis given
- 2 week if no prophylaxis
(Repeat GC and non-GC)

Other

  • syphilis q 6 wks
  • HIV 6,12,24 wks

Dont forget safe place to go, transportation etc

24
Q

Rape trauma syndrome?

A

Psychologic sequelae

acute/disorganization phase

  • hours - days
  • distortion/paralysis of coping mechanism

Integration/resolution phase

  • months - yrs later
  • flashbacks, nightmares, phobias
  • gyn/mensural complaints

PTSD

  • 50% of rape victims
  • Mitigate w acute crisis counseling
25
Q

Diagnostic criteria for PTSD?

A
Sx x 1 month
Exposure to trauma
Re-experience of trauma
Avoidance of the trauma
Increased arousal
Life dysfunction
26
Q

sex jokes are not funny. Period!

A

Bruh! Its not funny i mean cum on people