231/232 - Female and Male Sexual Dysfunction Flashcards Preview

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Flashcards in 231/232 - Female and Male Sexual Dysfunction Deck (35)
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List 4 requirements to generate an orgasm

  • Arousal
  • Physical stimulation 
  • Adequate blood flow 
  • Intact neurological system


Basically, central regulation + end organ physical stimulation

Hormones not required!


List 2 phsyical exam findings that are independent predictors of erectile dysfunction


Waist circumference



In people with a penis, what is the effect of oxytocin?


Also involved in orgasm


List 4 risk factors for secondary anorgasmia (in people with a vagina)

  • Vascualr disease
  • Neurologic disease/neuropathy
  • Pelvic floor disorders
    • Contractions required for orgasm
  • Gynecologic conditions
    • Ex: Lichen sclerosis



Which imaging modality is used to assess penile venous leak?

Which method is used to measure arterial insufficiency?

Venous leak: Cavernosometry

Arterial insufficiency: Pudendal angiography



Where in the brain are the neurotransmitters that stimulate libido?

What are they? (3)

Limbic system

  • Dopamine
  • Melanocortin
  • Norepinephrine


Estrogen and testosterone important, but they prime the hypothalamus to respond to the neurotransmitters; cannot stimulate arousal on their own

Limbic system controls emotions, motivations, pleasure


Which neurotransmitter is responsible for facilitating achievement and maintenence of an erection?

Nitric Oxide (NO)

  • Mediates vasodialtion -> increased blood flow

NO -> increased cGMP -> Decreased Ca2+ -> smooth muscle relax
-> increased blood flow 




Which neuotransmitters stimulate arousal? (4)

  • Dopamine*
  • Norepinephrine*
  • Nitric oxide
  • Acetylcholine


Result is genital-clitoral engorgement or erection


Also excitatory for libido


What is the "truest assessment" of natural erectile machinery?

Nocturnal erections


Can differentiate organic vs. psychogenic cause of ED

But even people without ED do not have a nocturnal erection every night


List 3 treatment options for premature ejaculation

  • Behavioral therapy
    • Stop/start or squeeze
  • Transdermal therapy - generally the mainstay
    • Numbing creams and sprays 
  • SSRIs



During an erection, compression of which veins prevents venous return, thus maintining the erection?

Compression of helical veins


Which nerves are responsible for each stage of the male sexual response?


  • Arousal:
  • Emission:
  • Expulsion:
  • Orgasm:

  • Arousal: Pelvic nerves (Parasympathetic)
  • Emission: Sympathetic T10-L2
  • Expulsion: Sympathetic S2-S4 + Pudendal 
  • Orgasm = central control


Ejaculation = emission + expulsion

Emission moves semen from epididymis to urethra

Expulsion -> out into the world


What defnes premature ejaculation?

Ejaculation within 2 minutes of initiation of penetrative sex

w/ associated poor control, bother, with nearly all partners and intercourse attempts


What is the #1 cause of erectile dysfunction?


(Mechanically speaking)

Venous leakage



What is apreunia?

Vagina does not undergo necessary changes to accomodate penetrative intercourse


Which neurotransmitter or hormone is most important for achieving orgasm?


  • Facilitates muscle contractions associated with orgasm
  • Secreted by paraventricular nucleus of the hypothalamus


Oxytocin = #1 facilitator of arousal and orgasm

Works synergystically with sex hormones to facilitate muscle contractions


Which area of the brain is responsible for triggering an erection?

Medial pre-optic area (anterior hypothalamus)

Coordinates brain and penis


PGN will stop sexual response if time is not appropriate


What is more important in generating libido: neurotransmitters or hormones?



Hormones can potentiate neurotransmitter signaling, but need excitatory neurotransmitters (Dopamine, norepinephrine, melanocortin)


MOA of Alprostadil in treating erectile dysfunction

Incrased cAMP production

  • -> increased PKA
  • -> Decreased Ca2+ (sequestered)
  • -> Smooth mucle relaxation 
  • -> Increased blood flow 




What are the first-line treatments for erectile dysfunction? (3)

  • Behavior/lifestyle change
  • Correct underlying medical issues 
  • Oral medications 


2nd line = more invasive; transurethral pellets, vacuum erection, intracavernosal injection

3rd line = Surgical intervention (penile prosthesis


Which artery supplies the penis?

Pudendal artery

-> Common penile artery

-> Superficial dorsal artery and deep cavernosal artery


MOA of PDE-5 inhiibitors in treating erectile dysfunction

PDE-5 normally degrades cGMP

PDE-5 inhibitors increase endognous cGMP 

  • cGMP
  • -> decreased Ca2+
  • -> smooth muscle relaxation
  • -> increased blood flow
  • -> erection




What percent of people with a vagina can achieve an orgasm without clitoral stimulation?




List 4 medical conditions that are associated with erectile dysfunction

  • Coronary artery disesae
  • Diabetes mellitus
  • Poorly controlled HTN
  • Dyslipidemia



MOA of Papaverine in treating erectile dysfunction

Inhibits degradation of cAMP

  • -> Increased cAMP
  • -> Increased PKA
  • -> Decreased Ca2+ (sequestered)
  • -> Smooth muscle relaxaiton
  • -> Blood flow 


List 4 medical treatments for delayed orgasm

  • Buproprion
  • Cyproheptadine
  • Amantadine
  • Yohimbine 


Describe the two pathways to orgasm in a person with a vagina

  • Primary
    • Clitoral stimulation -> Spinal cord -> brain
    • Releases oxytocin -> orgasm
  • Alternate
    • Vaginal/cervical stimulation -> Vagus/pelvic nerve -> orgasm



Where in the brain are the neurotransmitters that inhibit libido?

What are they? (3)

Prefrontal cortex

  • Serotonin
  • Prolactin
  • Opioids


Makes sense b/c prefrontal cortex regulates compulsive, reward-seeking behavior


Are hormones required for penile/vaginal intercourse?

No - they are helpful, but required


Most important factor is end-organ that is phsyically capable of accomodating intercourse


What defines female sexual dysfuction?

At least one of the following:

  • Problems with sexual desire, interest, or arousal
  • Orgasmic disorders
  • Sexual pain

That results in marked distress or interpersonal difficulty

NOT better explained by another primary psychiatric disorder or general medical condition



TY @Alba Gonzalez!