Sexual dysfunction Flashcards
(34 cards)
Classify sexual disorders
Desire and drive
- Hypoactive sexual desire disorders
- Sexual aversion disorder
Arousal
- Erectile dysfunction
- Female sexual arousal disorder
Orgasm
- Rapid ejaculation, delayed ejaculation, retrograde ejaculation
Resolution
- Sexual pain
- Dyspareunia
- Vaginimus
- Vulvodynia
Any sexual disorder must be
- Persistent
- Causes marked distress
Define hypoactive sexual desire disorder
Loss of libido and decline in sexual desire causing destress
Causes of hypoactive sexual desire disorder
Chronic disease
- DM
- CVD
- Anaemia
- Obesity
Hormonal
- Androgen deficiency
- Hyperprolactaemia
- Hypothyroid
Iatrogenic
- SSRI
- OCP
- HRT
- Surgery
Psychiatric
- Depression
- Anxiety
- Substance abuse
- Previous trauma
Treatment of hypoactive sexual desire disorder
Psychosexual
- CBT
- Psychodynamic
- Cognitive
- Intergrative
Medication
- Testosterone replacement (M)
- Flibanserin (F) for premenopausal women
Define erectile dysfunction
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
Causes of erectile dysfunction
Chronic
- CVD
- DM
- Neuro
Hormonal disorders
- Androgen deficiency
- Prolactin ( high)
Iatrogenic
- Prostate surgery
- SSRI’s
- HTN
Psychiatric
- Relationship problems
- Age
- Depression
Treatment of erectile dysfunction
1st Line
Phosphodiesterase inhibitors
Sildenafil
2nd line
Alprostadil
Non medical
- Vacum device
- Kegle excercises
- Psychological (psychosexual therapy)
Define female sexual arousal disorder
Failure of the genital response ( vaginal dryness)
Reduced interest in sexual activity, reduced physical response to sex stimuli and reduced sexual pleasure
Causes of female sexual arousal disorder
Chronic disease
- DM
- CVD
- Neuro
Hormonal
- Oestrogen deficiency
Iatrogenic
- SSRI’s
Lactation
Psychological
Treatment of female sexual arousal disorder
Behavioural
- Sensate focus
- Eros therapy device
- Lubricants
Psychosexual couples therapy
Define rapid ejaculation
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
Ejaculation occurs within 1 minute
Causes of rapid ejaculation
Genetic susceptibility Hyperthyroidism Penile hypersensitivity Psychological - Performance anxiety - Lack of experience - Issues - Early experiences
Treatment for rapid ejaculation
1st line
- SSRI’s ( Dapoxetine, increase risk of suicide)
- STUD 100 spray (topical anaesthetic)
- Psychosexual therapy
- Behavioural therapy (stop start technique, kegel exercise)
Define female orgasmic disorder
Orgasm either does not occur or is markedly delayed
Causes of female orgasmic disorder
Chronic
- DM
- CV
- Anaemia
- Obesity
Hormonal
- Androgen deficiency
- Hyperprolacteimia
- Hypothyroid
Pelvic floor weakness/damage
Ageing
SSRIs
Psychological
- Abuse
- Relationships problems
Treatment of female orgasmic disorder
Topical oestrogen
Behavioural interventions
- Guided masturbation
- Vibrators
Define vaginismus
Spam of the pelvic floor muscles that surround the vaginal opening.
Makes the penile entry painful or impossible
Causes of vaginismus
Thrush
FGM
Congenital abnormality
Psychological
Previous trauma/abuse
Fear/dislike partner or pregnancy
Misinformed
Treatment of vaginismus
Psychosexual Behavioural - Self exploration - Vaginal dilators - Graded penetration therapy
Define Dyspareunia
Pain during intercourse
Only used if there is no primary nonorganic sexual dysfunction
Can occur in males and females
Causes of dyspareunia
Females
SUPERFICIAL
- STI’s
- Episiotomies
- Vaginal atrophy
DEEP
- PID
- Endometriosis
Males
- STI
- Urethral strictures
- Varicocels
- Psychological
- Relationship causes ( poor technique of partner)
Treatment of dyspareunia
Treatments
- Lubricants
- Couples therapy
- Behavioural therapy
- Refer to Gynae
Define vulvodynia
Burning pain, occurring in the absence of relevant visible findings or a specific or a specific clinically identifiable neurological disorder
Treatment of vulvodynia
MDT approach 5%/ 2% lidocaine Pelvic floor exercise/ perineal massage TGA Gabapentin
