Disorders Flashcards
(41 cards)
What is hypoactive sexual desire disorder (HSDD) ?
Where a person loses their desire to have sex, which includes a decrease in fantasies.
Loss of sexual desire is the principal problem and is not secondary to other sexual difficulties, such as erectile failure or dyspareunia. Lack of sexual desire does not preclude sexual enjoyment or arousal but makes the initiation of sexual activity less likely.
What are the physical causes of HSDD?
High prolactin, Hypogonadism, Androgen deficiency, Anti-depressants and psychotics, orchidectomy, Hypothyroidism, Addison’s, Post pregnancy, OCP, HRT, Tamoxifen, Beta blockers, oophorectomy, obesity, CVD, DM, anaemia, tiredness, low mood, sleep problems, low concentration
Why do OCP, HRT and tamoxifen impact on desire?
they bind to testosterone
What are the psycholocial causes of HSDD?
mental health problems, stress, trauma or abuse, body dysmorphia, erotic dissatisfaction, relationship problems
What investigations do you do for HSDD?
FBC Oestrogen and testosterone Prolactin Glucose and lipid ratio TSH SHBG (Sex hormone-binding globulin), albumin ----> hypogonadism
What is the management for HSDD?
CBT
Psychodynamic therapies
Couple therapies
Sex education
Testosterone treatment – injection, patches, buccal or S/C
Therapies work on communication, normalisation, lessen performance anxiety and change unhelpful attitudes
What is the definition of erectile disorder?
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
What is the cause of erectile disorder?
Medical condition – CVD, DM, neuro eg MS
Hormones- androgen deficiency, hyperprolactinaemia
Iatrogenic- post prostate surgery, SSRIs or anti hypertensives
Age
Ineffective stimulus
Pain
Veno occlusive disorder
Mental health problems
Performance anxiety
Relationship problems
What is the management for ED?
PO: sildenafil, avanafil, tadalafil, vardenafil
Intra cavernousal injection: alprostadil
Intraurethral injection: alprostadil
Vacuum device, penile-scrotal rings
Kegel exercises
what is female sexual arousal disorder
Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
- Absent/reduced interest in sexual activity
- Absent/reduced sexual fantasies
- No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
- Absent/reduced sexual excitement during sexual activity
- Absent/reduced sexual interest/arousal in response to any sexual cues
- Absent/reduced genital or non-genital sensations during sexual activity
What are the physical causes of female sexual arousal disorder?
Medical: CVD, DM, neuro, connective tissue disorders, ME
Hormones: oestrogen low eg post menopause or thyroid disorders
Iatrogenic: antidepressants etc
Lactation
Irritants or douching
What are the psychological causes of female sexual arousal disorder?
mental health problems, abuse, decreased intimacy, relationship problems
What is the management of female sexual aroual disorder?
Lubricants
Sensate focus - A staged programme of exercises to enable the couple to identify own and others sexual likes/dislikes and explore new techniques etc. Work with therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour
Use of sex toys
Clitoral vacuum- low evidence
Psychotherapy
What is female orgasmic disorder?
Orgasm either does not occur or is markedly delayed or marked decrease in intensity.
What are the physical causes of female orgasmic disorder?
Medical- CVD, DM, neuro, renal/liver problems Androgen insufficiency, hypothyroidism pelvic floor damage!! Ageing SSRIs
What are the psychological causes of female orgasmic disorder?
Mental health problems Abuse Couple script problems Religion Stress Relationship problems
What is rapid /premature ejaculation?
A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration/ other forms of sexual activities and before the person wishes it.
What are the physical causes of premature ejaculation?
Hypersensitivity of penis Hyperthyroidism Prostatitis Comorbid sexual problem eg ED Amphetamines/MDMA/cocaine
What are psychological causes of premature ejaculation?
anxious Early learned experiences Lack of sexual activity Relationship problems Pain
What is the management of premature ejaculation?
DRE prostate exam
Anaesthetic locally applied eg spray or in condoms
SSRI eg dapoxetine
Couples’ therapy
Behavioural techniques- stop and squeeze, kegel exercises, mindfulness
What is delayed ejaculation?
On almost or all occasions (75-100%) either generalised or situational, without the individual desiring delay:
Marked delay in ejaculation or absence of ejaculation
What are physical causes of delayed ejaculation?
Congenital disorders Trauma or surgery age Infections Neurological eg DM, spine injury, alcohol neuropathy Depression SSRIs, thiazides, alpha blockers Low testosterone
What are psychological causes of delayed ejaculation?
insufficient stimulation, masturbation technique, abuse, poor body image, relationship and partner issues, pain disorder
What must you exclude in delayed ejaculation?
retrograde ejaculation
