Sexual Dysfunction Flashcards
(27 cards)
Erectile Dysfunction
persistent inability to attain or maintain an erection sufficient to permit satisfactory sex
ED prevalence
40 - 70 years
increases in age
Occult cardiac disease
ED risk factors
- obesity
- Increasing age
- CVD: angina
- HTN
Dyslipidaemia
DM
Metabolic syndrome: NAFLD
BPH: obstruction to the penis
Lifestyle factors: smoking, high alcohol intake, bike riding > 3 hours weekly
ED causes
vascular, neuronal, hormonal (increase PRL), uses of synthetic steroids, hyper/hypothyroid, low testosterone
Organic causes
- CVD, HTN, PAD, hyperlipidaemia, DM, Metabolic syndrome
- Neurogenic: Central degenrative order (MS, Parkinson’s), stroke
- Neurogenic: Peripheral: DM, CKD
Structural: Peyronie’s disease: pain, shortening and curvature of the penis
Endo: DM, Thyroid disorders, Cushing’s, Hyperprolactaemia,
ED Psychogenic cauases
Lack of arousal
situational: stress, relationship issues, depression
ED drug causes
- AntiHTN
- Diurectics
- ANtidepressant
- Antiarrhythmics
- Antiepileptic
- Cytotoxic
- Histamine antagonist
- Recreational drugs
ED HX taking
- PC when did it start?, How is stimulation acheive? Sexual desire? ejaculation? orgasm?
- Libido
- Gradual / sudden onset with Sx
When did you last have sex? gender of partners? type of sexual intercourse?
Sexual Hx: Pain during sex, cultural/religious beliefs
- Life events: recent child birth, new work? new home?
- Previous sexual / domestic abuse, past trauma
- impact
PMHx: HTN, CVD, Stroke, ?CP during sex ?SOB during sex
- Pelvic surgery
- revascularisation surgery
- BPH
- Previous episiode of ED
- Tx for ED
FMHX: CVD, DM
International index of ED questionaire
ED hardness scale
1 - Severe ED
2 - Moderate
3 - Suboptimal
4 - Optimal
ED examination
Ext. genitalia
?gynaecomastia
?hypogonadism - testicular atropy
?foreskin abnormalities: phimosis
? Penile struc: Peyronie’s
Testicular abnomralities: testicular lumps
ED Ix
BP, BMI, HR, Waist circumference
fasting testosterone between 9am -12pm (Precursor hormones to testosterone - FSH, LH, SHBG)
HbA1C
U&Es
TFTs
LFTs
Lipid profile
ED Mx
1st: Lifestyle Mx - reduce alcohol, smoking cessation, stop cycling, Weight loss, reverse underlying reversible conditions
2nd: Sildenafil 50mg (PDE-5 inhibitor), f/u 6-8/52
SEs: vasodilator - Low BP, Dizziness, fainting
3rd: Vacuum, Alprostadil inj, Medicated urethral sys. for erection, Vascular surgery, Penile prostheses
ED referral
Priapism - ED admission
Uro referral:
Endo: hypogonadism
Cardio referral: Sildenafil increase CV risks
MH referral for psy issues
Premature ejaculation
Inability to delay ejaculation
Normal - 5mins after penetration
abnormal: < 1 min after penetration
Premature ejaculation Mx
- SSRI, topical lidocaine
- Psy
- Educational
when there is ED with Premature ejaculation
ED needs to be address first prior to premature ejaculation
Femal sexual dysfunction
- sexual interest/arousal disorder
- female orgasmic disorder
- genito-pelvic pain/penetration disorder
(involuntary contractions: vaginisms)
Female sexual dysfunc risk factors
- Increasing age
- menopause
- genital surgery, FGM, genital atrophy
- sexual abuse
- Psy factors: relationship issues, alcohol, subs misuse, smoking, obesity
- Medical: CVD, DM, HTN, CKD, Urinary incontinence,
FSD causes
- Hormones: androgen/oestrogen particular, sexual func decreases w/ advance menopause
- Pregnancy: 1st/3rd trimesters, perineal trauma,
- CVD: atherosclerosis: loss of blood supply to the clitoris and vagina
What role do pelvic floor exercises play in managing female sexual dysfunction?
Pelvic floor exercises can strengthen the pelvic muscles, improve blood flow, and enhance sexual function and satisfaction.
