Sexual disorders

Question 1

List general physical causes of sexual health disorders

Answer 1

1. chronic disease e.g. diabetes, obesity, neurological disorders, cardiovascular disease
2. hormone disorders e.g. hyperprolactinaemia, thyroid dysfunction, oestrogen/androgen deficiency
3. local problems e.g. infections (STI), insufficient lube, irritation (thrush), congenital defects, tumour, cyst
4. FGM

Question 2

List general psychosexual causes of sexual health disorders

Answer 2

stress, depression, anxiety
past trauma or abuse 
alcohol use / illicit drugs e.g. cocaine
relationship problems e.g. sexual script 
low self esteem/ poor body image 
FGM

Question 3

List general iatrogenic causes of sexual health disorders

Answer 3

SSRIs

anti hypertensives e.g. beta blockers -> ED, alpha blockers -> retrograde ejaculation

local damage from surgery e.g. prostate surgery -> ED

Question 4

List behavioural interventions for sexual health disorders

Answer 4

stop start technique
sexual aids
vacuum device/ Eros device
guided self exploration

Question 5

What are the 4 types of psychosexual therapy used in sexual health disorders?

Answer 5

1. CBT
2. psychodynamic therapy
3. systemic therapy
4. integrative therapy

Question 6

What are the 5 key principles of couples therapy?

Answer 6

1. improve communication
2. modify dysfunctional behaviour
3. decrease emotional avoidance
4. change view of relationship
5. promote strengths

Question 7

What is included in a hormone blood test?

Answer 7

1. testosterone + SHBG + albumin
2. oestrogen
3. prolactin
4. thyroid function
5. progesterone
6. free androgen index
7. LSH /FH

Question 8

Describe the aim of CBT?

Answer 8

focuses on dysfunctional patterns of belief and behaviour in the HERE AND NOW

Question 9

Describe the principles of psychodynamic therapy

Answer 9

focuses on current problems and earlier patterns of response and behaviour from the past

Question 10

Describe systemic therapy principles

Answer 10

focuses on process and context and content to bring about change

Question 11

Describe integrative therapy principles

Answer 11

uses understanding and interventions from more than one approach

Question 12

Define male hypoactive sexual desire disorder

Answer 12

the lack/loss of sexual desire and persistent deficient sexual/erotic thoughts or fantasies about sex

Question 13

How is male hypoactive sexual desire disorder managed?

Answer 13

1. treat the cause!!

2. individual psychosexual therapy

Question 14

Define sexual aversion disorder

Answer 14

complete distaste and fear of sex

discussing sex is intolerable and distressing

Question 15

Define erectile dysfunction

Answer 15

difficulty in developing or maintaining an erection suitable for satisfactory intercourse

Question 16

List the causes of erectile dysfunction

Answer 16

PHYSICAL
chronic medical conditions
hormonal disorders
age related 
veno-occlusive disorder 

PSYCHOSOCIAL
performance anxiety, negative previous experiences
couple script problems 
sex education 
depression, substance misuse 

IATROGENIC
beta blockers, SSRIs, post prostate surgery

Question 17

Which medication can be prescribed for erectile dysfunction

Answer 17

1st line = oral PDE5 inhibitors e.g. sildenafil, avanafil, tadalafil

2nd line = injectable alprostadil - takes 45-60 mins to become effective

Question 18

Describe the mechanism of PDE5 inhibitors

Answer 18

phosphodiesterase type 5 inhibitors cause vasodilation in the penis

PDE5 inhibitors block the breakdown of cGMP causing prolonged action of vasodilators e.g. nitric oxide

this causes increased blood flow to the penis to cause an erection

Question 19

List the side effects of PDE5 inhibitors

Answer 19

headache
flushing
dizziness 
hypotension
stomach pain 
indigestion

Question 20

Outline the non-medical options to manage erectile dysfunction

Answer 20

vacuum device
penile/scrotal rings
kegel exercises
new stimulating routines e.g. lubricants, vibrators

Question 21

define female sexual arousal disorder

Answer 21

recurrent or persistent inability to attain sexual arousal or to maintain arousal until completion of sexual activity

Question 22

Outline DSM-5 features of female sexual arousal disorder

Answer 22

NEED >3 FOR DIAGNOSIS

1. reduced interest in sexual activity
2. reduced sexual/ erotic thoughts or fantasises
3. reduced/ no initiation of sexual activity and typically inceptive to a partners attempts to initiate
4. reduced sexual excitement/pleasure during sexual activity
5. reduce sexual arousal in response to any internal or external sexual cues
6. reduce genital/non genital sensations during sexual activity

Question 23

How is female sexual arousal disorder managed?

Answer 23

1. treat the cause! correct hormone issues
2. couples psychosexual therapy **
3. behavioural - eros device, sexual aids, sensate focus

Question 24

define female orgasmic disorder

Answer 24

marked delay, marked infrequency or absence of orgasms

Question 25

How can menopause affect sexual function?

Answer 25

``` vaginal dryness vaginal pain / pelvic pain change in libido change in mood, self image, cognition physical discomfort - sleeplessness, nigh sweats relationship problems ```

Question 26

Define rapid ejaculation

Answer 26

the inability to control ejaculation sufficiently for both partners to enjoy sexual interaction approx 1 min following vaginal penetration and before the person wishes

Question 27

List the possible causes of rapid ejaculation

Answer 27

``` PHYSICAL penile hypersensitivity hyperthyroidism prostatitis comorbid sexual health problems e.g. ED ``` PSYHCOSOCIAL anxiety lack of experience, infrequent sexual activity relationship issues

Question 28

Which medication can be used for rapid ejaculation?

Answer 28

topical local anaesthetic

Question 29

Define delayed ejaculation

Answer 29

marked delay, infrequent or absence in ejaculation

Question 30

Outline the possible causes of delayed ejaculation

Answer 30

PHYSICAL neurological disorders e.g. spinal cord injury, neuropathy trauma, surgery medication e.g. SSRI, alpha blockers, alcohol low testosterone levels ``` PSYCHOSOCIAL insufficient stimulation poor body image relationship factors poor sexual arousal ```

Question 31

What is important to exclude with a possible diagnosis of delayed ejaculation

Answer 31

retrograde ejaculation as can be a cause of infertility!

Question 32

Which sexual health disorder is an indication to do a physical examination?

Answer 32

vaginismus

Question 33

Define vaginismus

Answer 33

spasm of the pelvic floor muscles surrounding the vagina, causing occlusion of the vaginal opening

Question 34

how does vaginismus present?

Answer 34

persistent/ recurrent difficulties with >1 of the following.. 1. vaginal penetration during intercourse 2. vulvovaginal/ pelvic pain during intercourse 3. fear/anxiety about pain during/ anticipation of vaginal penetration 4. tensing or tightening go the pelvic floor muscles during attempted penetration

Question 35

What are the causes of vaginismus?

Answer 35

PHYSICAL vaginal conditions causing soreness FGM congenital abnormality ``` PSYCHOSOCIAL religious /cultural issues fear of pregnancy fear/dislike of partner previous sexual abuse/ trauma situational ```

Question 36

How is vaginismus managed?

Answer 36

1. treat cause! 2. individual psychosexual therapy 3. behavioural interventions - self exploration, kegel exercises, vaginal dilators

Question 37

Define dyspareunia

Answer 37

pain during intercourse

Question 38

List the causes of superficial dyspareunia

Answer 38

``` episiotomy recurrent infections e.g. herpes bartholins cyst urethritis menopause post radiotherapy insufficient lube / sexual arousal ```

Question 39

List the causes of deep dyspareunia

Answer 39

``` endometriosis pelvic tumours fibroids surgical adhesions PID constipation irritable bowel syndrome ```