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Sheff 3a > Sexual Medicne > Flashcards

Sexual Medicne Flashcards

1
Q

What is female sexual dysfunction

A

Disorder of 1 or more of
Sexual desire, arousal, orgasm, sexual pain (dyspareunia / vaginismus)
-> significant personal distress and reduced quality of life

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2
Q

Causes of female sexual dysfunction

A

Psych - previous trauma / abuse, body image, depression / anxiety

Social - relationship concerns, stress (work, wishes and fears, pressure to perform)

Biological - diabetes, vascular, hormone imbalance (eg menopause), alcoholism
Neurologcal - Eg cauda equina / paralysis

Drugs - SSRIs, b-blockers

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3
Q

Superficial and deep egs of dyspareunia ?

A

Superficial - thrush, herpes, vaginismus (pelvic floor spasm)

Deep - PID, endometriosis

Both - lack of lubrication

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4
Q

Ix in dyspareunia ?

A 
Sexual hx 
Physical exam - esp if in pain 
Bloods -glucose and lipids (DM/CVD) 
- sex hormones: testosterone, SHBG (sex hormone binding globulin), oestrogen 
Prolactin, TSH, FBC
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5
Q

Psychological treatments in sexual probs

A

Cognitive (addresses unhelpful thinking styles)

Behavioural (sensate focus = increasing touch exercises with partner, self growth programme)
Educations, sex toys, lubricant, kegel exercises

CBT (cognitive + behavioural combo)

Psychodynamic (unconscious though processes) - Eg unresolved conflicts and past dysfunctional relationships

Systemic (interactions and roles in relationship/ family dynamics)

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6
Q

Other than behavioural /psych treatments what can be done for female sexual issues?

A

Kegel exercises
Treat any medical causes
Oestrogen replacement
?androgen therapy

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7
Q

Erectile dysfunction
Causes?
Ix?
Mx?

A

Physiological - Neuro disease, CVD, androgen deficiency, prolactin, venoocclusive

Psychological - depression, substance abuse, performance anxiety, relationship problems, sexual script problems

Ix
Glucose, lipids, BP, testosterone

Mx 
Viagra
Injectable / intraurethral aloprostadil 
Vacuum device 
Penile / scrotal ring 
Kegal exercises 
Enhanced lube / vibrators
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8
Q

Causes of androgen deficiency?

A

Lack of testosterone, older men, obesity
Chemo / radiotherapy / mumps (affect testicular function)
Pituitary issue - adenoma / prolactinoma (stops production of gonadotropins)
Hypothalamic
Absent gonads

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9
Q

Mx of androgen deficiency in men ? CI/SE?

A

1st line - viagra (PDE 5 inhibitor)
Eg sildenafil, vardenafil
S/E - side effect, headache, facial flushing, dyspepsia
CI- hypotension

Injectable / intraurethral alprostadil
CI- partner is pregnant / tiring
S/E - penile fibrosis, priapism

Vaccum device - don’t use >30mins

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10
Q

Define rapid ejaculation?
Cause? Comorbid common?
Ix?
Mx?

A

Inability to control ejaculation sufficiently for both partners to enjoy sex

Physiological - penile hypersensitivity, hyperthyroid,
Psychological - Anxiety, early learned experience, lack of sexual experience, relationship issues

Co-morbid - erectile dysfunction

Ix
LFTs, lipids, sugar, testosterone, prolactin, TSH

Mx
Stud 100 spray - local anaesthetic
Couples therapy
Behavioural - kegal exercises , stop-start technique

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11
Q

Hypoactive sexual desire causes? Treatment?

A

Physiological - chronic disease, CVD, anaemia, DM, obesity, androgen deficiency, hypothyroid, hyperprolactinaemia

Psychological - previous abuse, sexual script, relationship problems, body image

Tx - psychosexual

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12
Q

What is couples therapy? 4 types?

A

Work together to overcome conflicts

CBT - focus on the dysfunction belief and behaviours in the here and now

Psychodynamic - relationship between current and past issues - explore

Systemic - process and context

Integrative - uses understanding + interventions from more than 1 approach

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13
Q

What is paraphilia ?

A

Sexually arousing fantasies / urges / behaviour that involves non human objects, suffering or children

Eg fetish, cross dressing

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14
Q

BV signs?
Cause?
Mx?

A

Grey/white discharge, raised pH, fishy odour, clue cells

Gardnerella vaginallis and mycoplasma hominis

Metronidazole / clindamycin

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15
Q

Treatment of candida Albicans? What if it is recurrent?

A

Clotrimazole pessary and cream (or tablets)

Fluconazole tablets if recurrent

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16
Q

Treatment choices for chlamydia ? What is related syndrome?

A

Azithromycin – 2 or 4 tabs at once
Doxycycline – two caps a day for a week

Reiter’s syndrome – conjunctivitis, uveitis and urethritis -> reactive arthritis

17
Q

Type of organism is gonorrhoea ? Treatment? Issues in pregnant? Birth?

A

Gram negative diplococcus

Ceftriaxone IM and oral azithromycin

Preterm, LBW, chrioamnionitis

Birth - purulent conjunctival discharge -> corneal damage

18
Q

Type of organism is trichomonas vaginalis ? Famous feature? Signs? Treatment?

A

Flagella Protozoa
Strawberry cervix
Green/grey smelly frothy discharge
Wet film -> polymorphonuclear leucocytes

Metronidazole

19
Q

Sexual health ix in aSx men ? What extra if sx?

A

First void urine CT/GC
NAAT
Syphilis / HIV serology

Dipstick
Urethral swab with GC culture

20
Q

Additional Ix in aSx MSM? If sx?

A

Pharyngeal / rectal swab for NAAT
Hep b serology

Gram stain and culture for CT/GC

21
Q

What is NAAT?

A

Nucleic acid amplification test

For virus / bacteria Eg chlamydia

22
Q

Sexual Ix in aSx women? Additional if Sx?

A

Endocervical / self taken Volvo-vaginal swab CT/GC NAAT
Syphilis /HIV serology

Wet and dry high vaginal swabs for candida, BV and trichomonas
Gram stain and culture for CT/GC

23
Q

Mx of candida?

A

Clotrimazole pessary
Oral fluconazole
Topical antifungal to remove itching

24
Q

How many are asymptomatic in gonorrhoea? Mx?

A

50% women (most men have sx)

Ceftriaxone 500mg IM + azithromycin 1g stat dose

CONTACT TRACING

25
Q 
Syphilis organism ? 
Stages? 
Ix?
Mx?
What often worsens prognosis?
A

Treponema pallidum
1- chancre (ulcer)

2- non-Prurtic maculopapular rash - ESP on soles and palms
Condylomata Lata - moist wart like lesions
Snail tract lesions
Viral type illness

Latent - positive serology with no symptoms

3- neurosyphilis, aortitis, gummatous

Ix - blood test
IM benzylpenicillin & contact tracing

Co-infection with HIV

26
Q

Herpes sx? Ix? Mx?

A

HSV 1 (oral) or 2

Painful blisters external genitalia and surrounding skin
-can have viral illness / discharge
Recurrent after a latent period - usually less severe

Viral culture

Oral acyclovir & abstain from sex until lesions cleared

27
Q

A 23 year old woman comes to see you because her boyfriend has recently noticed some discharge from his penis. He says it’s ‘fine’ but she is worried it might be something sinister. She has no symptoms herself.
You take endocervical swabs and culture shows a gram negative bacteria that is sensitive to doxycycline.

What organism is causing her infection?

A

Chlamydia trichomatis

28
Q

A 24 year old man sees you in GUM clinic. He has recently had unprotected sex with his male housemate. He admits to having tried IV drugs in the past.
What investigations are appropriate?

He has syphilis - what 2 approximate mx steps?

A

First void urine, pharyngeal/rectal swabs, Syphilis/HIV/Hepatitis B serology

IM benzylpenicilin & contact tracing

29
Q

Natural hx of syphilis?

A

Primary – chancre lesion
Secondary – palmar/sole rash (maculopapular), flu like symptoms
Latent phase
Tertiary – neuro, CV, Gummatous

30
Q

Man has mouth ulcers - which virus is most likely?

Could he give his GF genital ulcers through oral sex?

A

HSV1

Yes can cause genital as well as HSV2

31
Q

A 19 year old female visits you in GP. She is worried because she has noticed some ‘unusual’ discharge from her vagina. It doesn’t smell particularly and though she admits to being sexually active, she says she always uses condoms.
What investigations would you want to do?

Swabs come back clear - what advice?

A

Wet and dry high vaginal swabs, endocervical swabs, offer HIV/syphilis serology

Discharge is likely physiological - might be cycle related
Return to GP if any change or odour occurs

32
Q

Causes of delayed ejaculation in men? 4 from each category

A 
Psych 
Pressure to perform 
Previous sex problems 
Trust issues 
Guilt 
Poor arousal 
Lack of stimulation 
Relationship conflict 
Medication 
Radiotherapy 
SSRI 
Antipsychotics 
Pelvic surgery 
Physical 
Prostitis 
Neuropathy - Diabetes 
Congenital 
Trauma 
Neurological disorders -MS 
Decreased testosterone, increased prolactin 
Infectious disease
33
Q

main parts of IX for delayed ejaculation and what happens?

A

Physical exam
Penis, scrotum, epididymus, prostate, vas deferents

Bloods
PSA, prolactin, lipids, sex hormone binding globulin, TSH,FBC,

Swabs, Blood pressure

Urine sample -> sperm / fructose -> rules out retrograde ejaculation

34
Q

Management of delayed ejaculation

A 
Couples therapy 
Senate focus 
Individual CBT 
Personal sexual growth 
Kegals

Vacuum device - CI in warfarin
Viagra - CI if hypotension

35
Q

Investigations for reduced desire in women ?

A

Oestrogen, LH,FSH, GnRH, testosterone

TSH, prolactin, HbA1C, lipids, glucose, FBC

36
Q

Physical causes of female reduced desire ?>

A 
Menopause 
Depression 
Diabetes 
Hypothyroid 
Anaemia

Pelvic pain disorders
MS

Drugs
SSRIs, COCP, tamoxifen, HRT

37
Q

Impact of reduced desire on partner?

A 
Low self esteem 
Unwanted / rejected 
Inadequate 
Pressure on relationship 
Choose to leave 
Partner blames self -> Develops own sexual problems
38
Q

How does homosexuality affect treatment of reduced desrire ?

A

Doesn’t if they’re comfortable

If uncomfortable -> explore in therapy - how do they feel about self

39
Q

Management of female reduced desire ?

A 
Eros devise 
Senate focus, sexual growth 
Lube / oestrogen (vaginal dryness) 
Masturbation and exploration 
Individual and couple therapy 
Kegals

Sheff 3a (30 decks)

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