Sexual Health Flashcards
Define dysuria and dyspareunia
Dysuria - painful/burning on peeing
Dyspareunia - difficult or painful sexual intercourse
What is erectile dysfunction
Persistent inability to attain and or maintain and erection
Causes of erectile dysfunction
Vasculogenjc (CVD, HTN, HYPERLIPIDAEMIA, DM, SMOKING)
Neurogenic (MS, Parkinson, stroke, cKD, polyneuropathy)
Hormonal (hypogonadism causing low testosterone, hyperprolactinaemia , hyper / hypothyroidism , Cushings
Drugs - anti hypertensives (beta blockers, verapamil, clonidine), diuretics (spironolactone, thiazides), antidepressants, corticosteroids, ranitidine, marijuana, alcohol
Erectile dysfunction diagnosis
History
Morning total testosterone (highest in morning, so even if borderline normal in morning, it’s a problem)
If total serum testosterone borderline normal, tests free testosterone with FSH, LH and prolactin then refer to endocrinology for more tests
Erectile dysfunction management
Refer to urology if abnormality found on physical exam or if young patient
Refer to endocrinology if abnormal hormone levels
PDE 5 inhibitor (phosphodiesterase inhibitor) - sidenafil, tadalafil, vardenafil, avanafil - regardless of suspected cause unless they have a high cardiovascular risk
Possible causes of premature ejaculation
Prostatic is, thyroid disease or psychological distress
Premature ejaculation management
Psychosexual counselling
Topical anaesthetic
Dapoxetine (SSRI) as this causes delayed orgasms as a side effect - take 1-3 hrs before sexual activity
Causes of decreased libido
Low testosterone
Hypothyroidism
Anxiety/depression
SSRIs and SNRIs
Recreational drug use
What is anorgasmia
Persistent or recurrent delayed, infrequent or absent orgasms
Causes of anorgasmia
Neurological disorders, previous gynae surgery’s, medications (SSRIs or diuretics), alcohol or smoking, psychological problems
Management of anorgasmia
Treat underlying cause
Psychosexual counselling
Define Vaginismus
Involuntary contraction of vaginal musculature - can cause pain during vaginal penetration (gynae exam, tampon insertion or sexual intercourse)
Vaginismus causes
Psychological - prev sexual trauma
Vestibulodynia (tender at entrance of vagina) e.g. in post menopausal women due to oestrogen deficiency or due to previous genital surgery or skin disorders
Vaginismus presentation
Dyspareunia
Vagina, dryness
Inability to use tampons
Anorgasmia
History of previous trauma examination or sexual experience
May physically have signs of scarring or inflammation or entrance
Vaginismus management
Vaginal trainers
Psychosexual therapy
Topical lidocaine
Hormone replacement therapy for post hysterectomy, peri or post menopausal women
Pelvic floor exercises
Define atrophic vaginitis
Volvo vaginal atrophy, drying, inflammation secondary to declining oestrogen in peri or post menopausal women
Atrophic vaginitis presentation
Dyspareunia
Light bleeding following intercourse
Vaginal dryness/burning
Vaginal discharge
Pruritus vulvae - itchy vulva
Dysuria
Urinary urgency and incontinence
Polyuria
Recurrent UTIs
Atrophic vaginitis diagnosis and management
Pelvic examination
urinalysis to rule out UTI
Vaginal moisturisers
water based lubricants to use prior to sexual activity
Topical oestrogen - for menopausal atrophic vaginitis - used short term
Define oligozoospermia, asthenozoospermia and teratozoospermia
Oligozoospermia - low sperm count
Asthenozoospermia - reduced sperm motility
Teratozoospermia - high amount of abnormal shaped sperm
Define infertility
Failure to conceive after frequent unprotected sexual intercourse for at least one year
Causes of infertility
Sperm abnormalities
Ovulating disorders e.g. PCOS, premature menopause
Tubal damage from PID
Uterine or peritoneal disorders e,g, fibroids
Female infertility assessment
Serum mid-luteal phase progesterone - to confirm ovulation
Chlamydia testing for PID
Serum FSH and LH
Thyroid function tests
Serum prolactin
Hysterosalpinography (x ray that looks inside uterus and fallopian tubes to see if there is partial or full blockage) or ultrasonography
What to ask in history to check for female infertility
Length of time trying to conceive and sexual intercourse frequency
Menstrual cycle details
Galactorrhoea or hirsuitms
Thyroid dysfunction or diabetes
Symptoms for PID or endometriosis
History of STIs
Smoking and alcohol consumption
Male fertility assessment
Semen analysis - repeat if abnormal
Chlamydia testing
Imagining of urogenital tract
Testicular biopsy
Endocrine tests