Lecture 26: Sexual function and Dysfunction Flashcards Preview

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Flashcards in Lecture 26: Sexual function and Dysfunction Deck (42)
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1

Sexual Response Cycle

- Masters and Johnson 1966 --> observation and recordings of sex --> low levels of volunteers --> High proportion of prostitutes used for studies
1. Excitement (Arousal phase
2. Plateau
3. Orgasm
4. Resolution
5. Refractory period
Overall: groundbreaking research. tested and added too over the years

2

Descriptions for the phases of Sexual Response Cycle

1. Excitement (arousal phase): caused by any reflexogenix or psychogenic stimulation
2. Plateau: arousal reversible --> inevitable orgasm
3. Orgasm
4. Resolution: Involuntary period of tension loss (slower in woman than men)
5. Refractory period
- Increased HR, Change in BP, sweating, degree of dilitation

3

Sexual response cycle table

***

4

Kaplan 1979

Kaplan: feminist --> all about X and the Lack there of
3 phase model
1. Desire
2. Arousal
3. Orgasm
- forms basis of DSM IV classification of female sexual Dysfunction
Note: Linear models arent reality for many woman

5

Why are linear models not reality for the majority of woman?

1. disconnection b/w desire and orgasm
2. assumption: vasocongestion measures arousal
3. assumption: Orgasm reflects satisfaction (synonymous)

6

Basson's mode

Tries to separate desire and arousal --> bigger contention/problem for female sexuality (more than male sexuality)
Allows for consideration: Marital relationship --> husband more eager to have sex than female --> lack of female desire --> but becomes secondarily aroused during act

7

Categories of Sexual Problem Impairments

1. Physiological impairment (sexual dysfunction)
2. Non-Physiological impairment (human relations/difficulties in, consequences of, ways in which people conduct themselves sexually
a) Psychological
i) IntERsychic (Within the 2x people of the relationship/communication)
ii) IntRAsychic (beliefs, meanings, conflicts, guilt, shame, information deficiet/distortion, past sexual trauma, depression, anxiety, aversions, phobias
b) Social
i) situational (environmental)
Note: most common when have newborns/young children

8

PLISSIT model in regards to primary care of sexual dysfunction

- Annon and Robinson 1978
- Model for Sexual counselling --> interventions for common sexual dysfunctions of 4x levels of intensity
P: ERMISSION to talk about sexual matters, fantasize, enjoy sexuality
LI: Limited Information (response to patient's discussion)
SS: Specific Suggestions (e.g. retroverted uterus --> have sex ontop)
IT: Intensive Therapy

9

What is the most common female sexual complaint

Lack of desire
Medication: Flibanserin (Girosa)

10

3x Main reasons for Female Sexual dysfunction

1. disorder of sexual Interest or Arousal
2. disorder of orgasm
3. disorder of genito-pelvic pain/penatration
- dysparenuria
- vaginismus

11

What are the requirements for a complain of sexual dysfunction by both males and females

1. atleast 6 months
2. atleast 75-100% of time
3. results in atleast significant distress

12

What are the potentail variations in sexual dysfunctions for both males and female?

1. Lifelong or acquire
2. Generalised vs situational
3. Severity: mild, moderate, severe

13

Associated features of sexual dysfunction for both males and females

Factors:
1. partner
2. relationship
3. individual vulnerability factors/ psychiatric co-morbidity / stressors
4. cultural or religious
5. medical factors

14

Description of Associated features of sexual dysfunction for both males and females

Factors:
1. partner: partner sexual problem, partner health status
2. relationship: poor communication, discrepancies in desire for sexual activity
3. individual body factors: poor body image, history of sexual or emotional abuse, Psychiatric comorbidity: depression or anxiety. Stressors: job loss, bereavement
4. Cultural or religious: inhibitions related to prohibitions against sexual activity or pleasure. attitudes towards sexuality
5. Medical: factors relevant to prognosis, course or treatment

15

Treatment of Female Sexual Dysfunction

1. Is there really a problem: If so Whose problem (which partner) and Check associate features of partner (past sexual abuse/domestic violence)
2. Education:
3. Counselling:
a) Patient Couple
b) Sensate focus (ban sex, RE-ESTABLISH INTIMACY by starting at foundation)
c) manage medical problem
- "menopause" --> sexual function issues:
i) consider hormone replacement therapy --> topic oestrogen --> adds robustness to vaginal mucosa --> increased lubrication and hence decreased pain during sex
ii) physiotherapy --> added strength to pelvic floor muscles

16

4x main reasons for Male Sexual Dysfunction

1. Hypoactive sexual disorder (decreased libido)
2. Erectile
3. Ejaculation: Delayed (retarted) or Premature (rapid)
Note: biased research as most researchers are men --> know more about male sexual dysfunction

17

Cuases of Hypoactive sexual disorder/Low libido in men

1. Psycholocial
a) fatigue
b) situational
c) depression --> treament drugs further worsen sexual dysfunction
2. Physical
a) hypothyroidism
b) hypogonadism
c) PADAM (Partial Androgen deficiency in Aging Males)
3. Other: Medicaiton (e.g. antidepressants)

18

PADAM

Partial Androgen Deficiency in Aging Males
--> extreme hypogonadism disproportionate to rate of male aging
Treatment: Testosterone supplementation

19

What are the nerve pathways to penile erections?

Visual, imaginative, auditory, emotional or olfactory sex stimuli to brain --> No release --> increase in cGMP in penile areas --> increased smooth muscle/erectile tissue relaxation --> increased blood flow into corpora cavernosum (arterial expansion)--> compression of veins distended lacunae and cavernous sinuses --> erection --> PDE-5 enzyme breaks down cGMP --> acoids thrombosis + decreases erection
Note: disruption on any level can cause problems
Pelvic level: Contains reflex arch (tactile response cremasteric reflex) --> allows men with spinal cord injuries still being able to get erect --> reflex arch at pelvic level is a tactile response in nerve pathway

20

What is a special loop hole in the Nerve pathway to penile erection?

Reflex arch at pelvic level (tactile response cremasteric reflex)
Clinically: means men with spina cord injuries are still able to get erect (tactile response nerve pathway)

21

What sort of instrument is the penis

Penis isnt a muscle
Hydrolic instrument

22

Components of Penis Flaccid --> Erect

1. Circumflex vein
2. Cavernous sinuses
3. tunic albuginea
4. Helicine arteries
5. Cavernous arteries

23

Erectile Difficulties requirements

Persisitent inability, for alteast 3 months, to obtain and maintain sufficient and satisfactory sexual performance
Note: DSM-5: 6 months

24

Relating features to erectile difficulties

1. Prevalance increases with age (paralleled to increased rate of organic illnesses with age)
2. Organic vs Psychogenic
- incident w. failure to become erect --> psychological reaction --> perpetuates erectile loss
3. Chronic illnesses (decreased libido/interest), surgery (interruption of fine vessels), trauma (spinal or pelvic)
4. Midifiable risk factors

25

Chronic Illnesses causing Erectile Dysfunction

1. Systemic (atheroscleorisis, dibatere, CVD, renal/heaptic failure)
2. Neurogenic (alzhiemers, multiple sclerosis)
3. Penille disorder (Peyrones) /Psychiatric (depression + performance anxiety) /Endocrine (hyper/hypothyoidism, hypogonadism, hyperprolativemia)
Note: Peyrones disease --> Trauma/clot/inflammation --> fibrosis to Tunica --> distortion of erect penis --> hard to achieve

26

Surgery and Trauma as causes of Erectile Dysfunction

1. Neurological (spinal cord)
2. Pelvic (injury, surgery, irradiation of pelvic region)
3. Urological (prostatectomy) --> disruption of fine nerves supplying penis --> risk of impotence with prostatic surgery

27

Prevalence of Erectile Dysfunction

1. No impotence: 48%
2. Minimal: 17%
3. Moderate: 25%
4. Complete impotence: 10%
Note: changes would have occurred by now, as this study occurred in 1987-69
Additionally: biased results as involved relatively older test patients (40-70 years)
Overall: 52% of men experience some degree of erectile dysfunction

28

Associated of Prevalance of Erectile Dysfunction with age

Overall: Increased probability of ED with age
1. 40 years --> 39% risk of ED
2. 50 years --> 48% risk of ED
3. 60 years --> 57% risk of ED
4. 70 years --> 76% risk of ED

29

Modifiable risk factors which can decrease risk of Erectile dysfunction

1. Alcohol
2. cigarette
3. Drugs (antihypersensitives, anti depressants, hormones, tranquilizers, miscellaneous (NSAIDS, H2RA, cocaine, heroine)

30

Etiology behind Erectile Dysfunction

1. Organic (vasculogenis, neurological, hormonal or cavernosal abnormalities/lesions)
2. Psychogenic (central inhibition of erectile mechanism w/o physical insult) --> typically secondary to original ED occurrence --> continued stress of reoccurrence --> Physchogenic problems