Sexual dysfunction

Question 1

What is the sexual response cycle?

Answer 1

Desire
Arousal, excitement
Orgasm
Resolution

Question 2

What are the dx categories of sexual problems?

Answer 2

Desire
Arousal
Orgasm
Pain

Question 3

What can cause sexual dysfunction?

Answer 3

• Hormonal factors (e.g., low testosterone, high prolactin, low luteinizing hormone, high estrogen)
• Vascular factors (malfunctions in arterial or venous blood flow, esp. arteriosclerosis, atherosclerosis, and “venous leakage”
• Neurological factors (cerebral lesions, pituitary lesions, hypothalamic lesions, spinal lesions, problems in the peripheral nervous system [esp. caused by diabetes and renal disease])

Question 4

What drugs can cause sexual dysfunction?

Answer 4

1. Psychotropic
   - Antipsychotics
   - Antidepressants
   - Anxiolytics
   - Sedatives
   - Anti-convulsants and Lithium
2. Antihypertensives
3. Oral estrogen
4. Rec/street drugs (alcohol, heroin, methadone, cigarettes, caffeine)

Question 5

What is the PLISSIT Model of sex therapy?

Answer 5

Permission
Limited information
Specific suggestions
Intensive therapy `

Question 6

SRI induced sexual problem fixes?

Answer 6

-Reduce dose
-Switch agents (e.g. Wellbutrin (bupropion), Remeron (mirtazepine))
-Augment with Wellbutrin (50-100 mg daily)
Cyproheptadine (Periactin, 4 mg, 1-2 hr before sex)
-SRI weekend holiday (except Prozac (fluoxetine))