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Flashcards in Lecture 24 Deck (42):
1

Describe the Masters and Johnson sexual response cycle?

1. Excitement.
2. Plateau.
3. orgasm and ejaculation.
4. Resolution.
5. Refractory period.

2

Describe the excitement phase of the Masters and Johnson sexual response cycle?

This is the arousal phase, it is a result of any source of reflexogenic or psychogenic stimulation.
Females - there is lubrication and early expansion of the vagina. Swelling of the clitoris and nipples may become erect.
Males - penis becomes erect, the testes draw closer to the body and nipples may become erect.

3

Describe the plateau phase of the Masters and Johnson sexual response cycle?

This is where arousal moves from reversible to the inevitability of orgasm.
Females - the vulva swells, the vagina lengthens and there is deepening vasodilation of genitalia.
Males - there is deepening vasodilation of genitalia and pre-ejaculatory fluid.

4

Describe the orgasm phase of the Masters and Johnson sexual response cycle?

Females - muscular contractions of outer 1/3 of the vagina the uterus and the anal area. There are pleasant sensations felt in genital and pelvic area.
Males - muscular contractions involving the penis, perineum. there is also contraction of the prostate gland and seminal vesicles. Ejaculation occurs.

5

Describe the resolution phase of the Masters and Johnson sexual response cycle?

This is the involuntary period of tension loss (slower in women than in men).
Females - there is return to baseline or unaroused state.

6

Describe the refractory period phase of the Masters and Johnson sexual response cycle?

Females - time delay before plateau stage can be re-entered.
Males - penile erection may be obtained but orgasm can't occur. Period lengthens with age and fatigue.

7

Decribe the 1979 Kaplan 3 phase model?

Desire -> Arousal -> Orgasm.
This forms the basis of the DSM IV classification of female sexual dysfunction. However the difficulty such linear models don't represent reality especially for many women. For instance there may be a disconnection between desire and orgasm in some women sometimes. Assumption that genital vasocongestion is a measure of arousl. Orgasm and satisfaction may not be synonymous.

8

What are the two broad categories of sexual problems?

1. Impairments to physiology i.e. sexual dysfunction.
2. Impairments in the "human relations" part of sexual experiences i.e. difficulties in, or consequences of, the ways people conduct themselves sexually (what are the diseases around this?).

9

What are the two types of psychological sexual dysfunction?

1. Interpsychic e.g. relationshis, communication.
2. Intrapsychic e.g. beliefs, meanings, conflicts, guilt, shame, information deficit or distortion, past ssexual trauma, depression, anxiety, aversions, phobias.

10

Describe social sexual dysfunction?

This is situational e.g. environment important. Sense of awareness of what is going around (i.e. aware the mother in law is in the next room).

11

Describe the PLISSIT model?

This was done by Annon and Robinson in 1978 it is a model of sexual counselling. It suggests interventions for some common sexual dysfunctions. The interventions will occur at 4 levels of complexity:
P - Permission to talk about sexual matters, fantasize, enjoy sexuality.
L & I - Limited Information.
S & S - Specific Suggestions.
I & T - Intensive Therapy.

12

Decribe female sexual dysfunction?

It can be the following:
1. Sexual interest/arousal disorder - low desire the 'most commonly' reported female sexual complaint (fibanserin was FDA approved in 2015).
2. Female orgasmic disorder.
3. Genito-pelvic pain/penetration disorder (dyspareunia and vaginismus).


13

What is the criteria for female sexual dysfunction?

1. It must be experienced 75-100% of the time.
2. The minimum duration needs to be approximately 6 months.
3. That it causes significant distress.
4. Lifelong VS acquired disorder.
5. Generalised VS situational.
6. Severity scale: mild, moderate or severe.

14

What are the associated features of FSD?

1. Partner factors - e.g. partner sexual problem; partner health status.
2. Relationship factors - e.g. poor communication, discrepancies in desire for sexual activity.
3. Individual vulnerability factors (e.g. poor body image; history of sexual or emotional abuse), psychiatric co-morbidity (e.g. depression; anxiety) or stressors (e.g. job loss; bereavement).
4. Cultural or religious factors (e.g. inhibitions related to prohibitions against sexual activity or pleasure; attitudes toward sexuality).
5. medical factors relevant to prognosis, course or treatment.

15

What is the treatment for FSD?

1. Is there really a problem? whose problem? check "associated features" including: past sexual abuse and domestic violence.
2. Education.
3. Counselling - patient/couple and sensate focus.
4. Manage medical problems - 'menopause', consider hormone replacement therapy (e.g. oestrogen topically), and physiotherapy.

16

Describe male sexual dysfunction?

1. Male hypoactive sexual desire (low libido).
2. Delayed ejaculation (male orgasmic disorder).
3. Erectile disorder.
4. Premature ejaculation.

17

What is the criteria for male sexual dysfunction?

1. It must be experienced 75-100% of the time.
2. The minimum duration needs to be approximately 6 months.
3. That it causes significant distress.
4. Lifelong VS acquired disorder.
5. Generalised VS situational.
6. Severity scale: mild, moderate or severe.

18

What are the associated features of MSD?

1. Partner factors - e.g. partner sexual problem; partner health status.
2. Relationship factors - e.g. poor communication, discrepancies in desire for sexual activity.
3. Individual vulnerability factors (e.g. poor body image; history of sexual or emotional abuse), psychiatric co-morbidity (e.g. depression; anxiety) or stressors (e.g. job loss; bereavement).
4. Cultural or religious factors (e.g. inhibitions related to prohibitions against sexual activity or pleasure; attitudes toward sexuality).
5. medical factors relevant to prognosis, course or treatment.

19

What are the psychological factors of low libido in men?

1. Fatigue - mainly psychological (also physical).
2. Sensational factors - basically it is not always there.
3. Depression - drugs used to treat depression also create sexual dysfunction.

20

What are the physical factors of low libido in men?

1. Hypothyroidism.
2. Hypogondism/low testosterone - gonads aren't producing enough testosterone.
3. Partial androgen deficiency in the ageing male (PADAM).

21

What are other factors of low libido in men?

Medication.

22

Describe the biochemical mechanism of penile erection?

1. In the brain sexual signals will stimulate NO (Nitric Oxide) release which in turn will increase cGMP levels in certain areas of the penis.
2. cGMP will cause smooth muscle relaxation of erectile tissues and arterial expansion which allows for increased blood flow into the corpus cavernosum; at this time veins are compressed, leading to an erection.
3. PDE 5 enzyme destroys cGMP and limits the erection.

23

Describe erectile difficulties?

Erectile dysfunction is
'persistent inability, for at least 3 months, to obtain and maintain an erection sufficient for satisfactory sexual performance' this needs to occur for at least 6 months. There is organic vs psychogenic ED. It can also be due to chronic illness, surgery, or trauma. There are also modifiable risk factors.

24

Describe the prevalence of ED?

It will increase with age.
40-70yo men:
48% will experience no impotence.
17% will experience minimal impotence.
25% will experience moderate impotence.
10% will experience complete impotence.

25

Describe basic management of ED?

1. Diagnosis.
2. Co-morbidities e.g. heart disease, vascular disease, depression, lipid disorders, diabetes and LUTS.
3. What does the couple want?
4. Adjust medication (in case of side effects).
5. Address lifestyle issues (cigarette smoking; alcohol consumption, diet and exercise).
6. Education.
7. Tailored treatment.

26

What are the common causes of ED?

1. Organic - due to vasculogenic, neurological, hormonal, or cavernosal abnormalities or lesions.
2. Psychogenic - due to central inhibition of the erectile mechanism without a physical insult.
However, in most patients with ED, a combination of organic and psychogenic component is involved.

27

Describe performance anxiety?

Performance anxiety which will increase loss of confidence which will cause lack of interest which can cause performance anxiety. Treatment will break the feedback loop of performance anxiety. Mindfulness based approaches as a component of treatment.

28

What are the 3 PDE 5 inhibitors?

1. Sidenafil.
2. Tadalafil.
3. Vardenafil.

29

Describe sidenafil?

This is also known as viagra. it's generically now available (at a lower cost to the patient).

30

Describe tadalafil?

This is also known as cialis. There is longer duration of action, and an option of low dose (5mg) daily (it maintains oxygenation thus improving endothelial smooth muscle health).

31

Describe vardenafil?

This is also known as levitra. There is a shorter duration of action.

32

What are the other approaches to ED?

1. Alprostadil (caverject).
2. Bimix - papaverine and phentolamine.
3. Trimix - prostaglandin (PGE 1), papaverive and phentolamine.
4. ED shock wave therapy.
5. Vacuum device.
6. Surgery.

33

Describe rapid (premature) ejaculation?

Subjectively it is defined as when ejaculation occurs before the individual wants it to (not quantitative).

34

What are the traditional theories of rapid ejaculation?

1. Furtive early masturbation.
2. The 'too exciting vagina'.
3. Genital hypersensitivity.
4. Lack of alarm signal.

35

What are the traditional therapeutic responses?

1. Sensate focus with 'squeeze' technique.
2. 'Stop-start' technique.
3. Local anaesthetic spray (Benzocaine).

36

Describe the neurobiological response to rapid ejaculation?

There is anecdotal evidence that men on SSRis experience delayed ejaculation. There is experimental evidence of:
-decreased serotonin neurotransmission.
-Hypofunction of 5-HT2c receptor.
-Familial aspects.
Is PE a normal phenomen in nature? Pharmacotherapy: SSRI daily; or clomipramine daily or 12 hours before sex. Dapoextine (priligy) 30mg or 60mg.

37

Describe delayed (retarded) ejaculation?

No consensus operational definition, generalised or situational.

38

What is the prevalence of DE?

Lifelong DE is relatively uncommon 1.5 per 1000 (3-4%).

39

What is DE classically attributed to?

Fear, anxiety, hostility and relationship difficulties.

40

What is the contemporary theory of DE?

Waldinger's Ejaculation Distribution Theory (EDT).

41

Describe acquired DE?

Could be psychological or in some disease states e.g. neurological conditions, DM.

42

What is the medication of acquired DE?

SSRIs, Tricyclic antidepressants, antipsychotics and others.