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Phase 3a > Gynae 3 - Urogynae and sexual health > Flashcards

Gynae 3 - Urogynae and sexual health Flashcards

1
Q

What is overactive bladder syndrome?

A

Urgency with or without urge incontinence

Frequency and nocturia

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2
Q

What is the commonest cause of overactive bladder syndrome?

A

Detrusor overactivity

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3
Q

What are the required investigations in overactive bladder syndrome?

A

Urine culture to exclude infection
Frequency/volume chart
Urodynamics

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4
Q

What is seen with urodynamic investigation in overactive bladder syndrome?

A

Involuntary detrusor contraction during the filling phase

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5
Q

What is conservative management of OBS?

A

Decrease liquids
Avoid caffeine
Bladder re-training (first line) - suppress urinary urge and extend interval between voidings

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6
Q

What is the pharmacological management of OBS?

A

Oxybutyin or tolterodine (anticholinergic drugs)

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7
Q

What is a utero-vaginal prolapse?

A

Protrusion of the uterus and/or vagina beyond normal anatomical confines

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8
Q

What is a urethrocele?

A

Prolapse of lower anterior vaginal wall, involving urethra

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9
Q

What is a cystocele/cysto-urethrocele?

A

Prolapse of upper anterior vaginal wall involving bladder +/- urethra

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10
Q

What is the name for a prolapse of the uterus, cervix, and upper vagina?

A

Apical prolapse

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11
Q

What is an enterocele?

A

Prolapse of the upper posterior wall of the vagina

Resulting pouch contains loops of bowel

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12
Q

What is a rectocele?

A

Prolapse of the lower posterior wall of the vagina, involving the anterior wall of the rectum

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13
Q

What is procidentia?

A

Grade 3 utero-vaginal prolapse - pouch extends beyond the introitus

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14
Q

What are the main symptoms of utero-vaginal prolapse?

A

Dragging sensation/pain/backache
Urinary changes
Constipation
Symptoms worse with prolonged standing

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15
Q

How is utero-vaginal prolapse investigated?

A

USS
Urodynamics if urinary changes
Modified oxford system for pelvic floor muscle strength

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16
Q

What are the risk factors of utero-vaginal prolapse?

A

Prolonged labour
Chronic cough/constipation
Non-compliance of post natal pelvic floor exercises

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17
Q

What is surgical management of utero-vaginal prolapse?

A

Anterior compartment defect: anterior colporrhaphy

Posterior compartment defect: posterior colpoperineorrhaphy

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18
Q

What is first line and second line treatment of utero-vaginal prolapse?

A

Pelvic floor muscle exercises

Vaginal pessary and oestrogen cream (ring pessary if sexually active)

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19
Q

What is stress urinary incontinence?

A

The involuntary leakage of urine on effort or exertion, sneezing, coughing

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20
Q

What is the most common risk factor for SUI?

A

Childbirth denervates the pelvic floor

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21
Q

How is SUI demonstrated?

A

Ask patient to cough

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22
Q

What are the investigations needed in SUI?

A

Midstream urine sample
Frequency/volume chart - normal
Urodynamic studies confirms

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23
Q

What is first line treatment of SUI?

A

3 months pelvic floor muscle training

24
Q

What is pharmacological treatment of SUI?

A

Duloxetine not offered anymore

25
Q

What is surgical management of SUI?

A

Open colposuspension

26
Q

What is the treatment of urge incontinence?

A

Bladder re-training

Oxybutynin

27
Q

What is overflow incontinence?

A

Bladder becomes large and flaccid with little or no detrusor tone
Bladder leaks when full

28
Q

How is overflow incontinence diagnosed?

A

Urinary residual is more than 50% bladder capacity

Bladder palpable after urination

29
Q

Give three physical causes of sexual health disorders

A

Chronic disease - CV disease, diabetes
Hormone - thyroid dysfunction, hyperprolactinaemia
Local - infections, irritations, endometriosis

30
Q

Give three psychosocial causes of sexual health disorders

A

Stress/depression/anxiety
Low self esteem
Past trauma or abuse

31
Q

Give three iatrogenic causes of sexual health disorders

A

SSRIs
Antihypertensives (BB -ED; Alpha-blockers - retrograde ejaculation)
Local damage from prostate surgery

32
Q

What is sexual aversion disorder?

A

Complete distaste/fear of sex
Discussion is distressing
Generally psychological, treated with psychosexual therapy

33
Q

What is hypoactive sexual desire disorder?

A

Lack of libido

Treat cause

34
Q

Give three causes of erectile dysfunction

A

Diabetes mellitus/CVD
Low testosterone
SSRIs
Prostate surgery

35
Q

Give an example of non-medical treatment of erectile dysfunction

A

Vacuum device/penile ring

36
Q

What is the medical treatment of erectile dysfunction?

A

Sildenafil, tardalafil, vardenafil/injectable alprostadil

Need stimulation to work

37
Q

What are the features of female sexual arousal disorder?

A 
Little interest in/thought about sex
Decreased initiation of sex
Little pleasure during sex
Little physiological response to sex
Decreased interest in sex when exposed to erotic stimuli
(need at least 3)
38
Q

What are three causes of female sexual arousal disorder?

A

SSRIs
Psychological
Oestrogen deficiency

39
Q

What are three physical causes of rapid ejaculation

A

Hyperthyroidism
Prostatitis
ED

40
Q

What are three psychological causes of rapid ejaculation?

A

Lack of experience
Anxiety
Time-pressure

41
Q

What is the treatment of rapid ejaculation?

A

Local anaesthetic
Psychosexual therapy
Behavioural techniques- stop start

42
Q

What are the causes of delayed ejaculation?

A

SSRIs
Neuropathy/spinal injury
Pressure

43
Q

What are three causes of dyspareunia/vaginismus?

A

Infection
Endometriosis
Insufficient lubrication
Trauma or abuse

44
Q

What is vaginismus?

A

Involuntary contraction of the lower 1/3 of vaginal muscle, leading to difficult/painful penetration

45
Q

What is the management of vaginismus?

A

Psychosexual therapy

Behavioural therapies - guided self exploration, vaginal dilators, sensate focus

46
Q

What are three types of psychosexual therapy?

A

CBT
Psychodynamic therapy
Systemic therapy looks at the problem as a whole
Integrative therapy - multiple treatment types

47
Q

What are the 5 key principles of couples therapy?

A 
Improve communication
Modify dysfunctional behaviour
Decrease emotional avoidance
Change view of relationships
Promote strengths
48
Q

What are the principles of an asymptomatic screen in GUM clinic?

A

First void urine for NAAT (chlamydia/gonorrhoea)
HIV and syphilis blood tests
HepB/HepC serology for high risk

49
Q

Which groups are considered high-risk for HepB/HepC?

A

IVDUs
Sex workers
MSMs

50
Q

When is a symptomatic screen appropriate in GUM clinic?

A

Present with discharge/dysuria

51
Q

Outline a symptomatic screen in GUM clinic

A

High vaginal swab
Urethral swab
Pharyngeal and rectal swab depending on exposures
Urinanalysis

52
Q

What is primary prevention in GUM?

A

Education and awareness
Hep B vaccination
Free condoms

53
Q

What is secondary prevention in GUM?

A

Target screening

Contact tracing

54
Q

What is tertiary prevent in GUM?

A

Treat the disease

55
Q

What is the general treatment of pre-menstrual syndrome?

A

Regulate carbohydrate intake, reduce saturated fats and caffeine, and reduce salt intake

56
Q

What is the treatment of PMS/PDD?

A

Continuous COCP
SSRIs
CBT

57
Q

What is the treatment of a vaginal vault prolapse?

A

Sacrocolpoplexy

Phase 3a (18 decks)

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