Sexual Function and Dysfunction Flashcards Preview

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Flashcards in Sexual Function and Dysfunction Deck (30):
1

 What are the two broad categories of Sexual problems

  1. Impairments to physiology ie: sexual dysfunction
  2. Impairments in the human relations part of the sexual experiance ie: diffiulties/consequences of the ways people conduct themselves sexually

2

What types of non-physiological sexual dysfunction is there?

Psychological:

  • interpsychic- relationships, communication
  • Intrapsychic- beliefs, meanings, conflicts, guilt, shame, information distortion, past sexual trauma, depression/anxiety

Social:

  • Situational

3

Whats the PLISSIT model?

Developed as a solution for sexual counselling.

Suggests interventions for some common sexual dysfunctions.

4 levels of complexity:

Permission to talk about sexual matters, fantasize

Limited Information

Specific Suggestions

Intensive Therapy

4

Female Sexual Dysfunction

Sexual interest/aurosal disorder: low desire the most common complaint.

Female orgasmic disorder
Genito-pelvix pain/penetration disorder

-Must be 75-100% of the time
-minimum duration of ~6months
-cause significant stress

 

Lifelong vs acquired
Severity scale

5

Associated factors of female sexual dysfunction

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6

Treatment of FSD

Is there really a problem? Who's problem is it?

Education

Counselling:
-patient/couple
-sensate focus

Manage medical issues: menopause, hormone replacement therapy, physiotherapy

7

Male Sexual Dysfunction

  • Male hypoactive sexual desire disorder
  • Delayed ejaculation
  • Erectile Disorder
  • Premature ejaculation

***same associated factors as women

 

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8

Low libido in men

  • Psycholoical: fatigue, situational factors, depression
  • Physical: hypothroidism, hypogonadism (low testosterone), PADAM
  • Other: medication

9

Biomedical mechanisms in getting an erection

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10

Anatomy of a flaccid penis

During erection these arteries (helecine and cavernossus) swell and compress the veins

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11

Definition of Erectile Dysfunction

Persistant inability for at least 3 months, to obtain/maintaina n erection sufficient for satisfactory sexual performance

-Increases with age

Organic vs psychogenic

-Chronic illness, surgery, trauma

12

What percentage of men age 40-70yrs experiance ED?

~52%

only around 10% full impotence

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13

What is the Cause of Erectile Dysfunction

Organic: vascular, neurological, hormonal issues

Psychogenic: usually secondary

Can be a combo of both

 

Eg: systemic disease, neurogenic disease, penile dosorder, psychiatric dsorder, endocrine disorder

14

Chronic Illness: a penile disorder example?

Peyronie's disease: a fibrous change, a thickening in the tunica (from previous inflamm process) → physical distortion of the erect penis. 

1/3 get better, 1/3 get worse, 1/3 stay the same

15

How can prostate surgery be an issue?

Can damage many vessels/nerves → erectile dysfunction

16

What types of surgery can lead to erectile dysfunction?

Spinal cord injury

Pelvic injury/surgery

Prostatectomy

17

Modifiable factors of Erectile Dysfunction

  • Alcohol consumption
  • Cigarette smoking
  • Drugs: anti-hypertensives, anti-depressants, hormones, tranquelizers etc

These can be controlled by the patient!

18

Basic Management of ED

Diagnose the issue
Evaluate co-morbidities: heart disease, vascular disease, depression
What does the couple want?
Adjust meds
Address lifestyle
Education
Tailored treatment

19

Why/how is a lot ofthe psygoneic issues secondary?

Something goes wrong → loss of confidence →lack of interest → performance anxiety → sexual dysfunction/ actual issues during the sexual experiance

20

Treatment for performance anxiety and ED

Mindfulness based approach a component 

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21

Non-invasive options for Erectile Dysfunction treatment

  • eliminate modifiable risk factors
  • Counselling and/or psychotherapy
  • medication
  • vacuum constriction devices

22

Invasive therapy trreatments for ED

  • Transurethtral drug application
  • Intracavernous injection therapy
  • Prosthesis implantation
  • Venous/arterial surgery

23

Phosphodiestarase 5 inhibitors (PDE5) used are?

  1. Sildenafil: 'viagra'
  2. Tadalafil: 'Cialis' longer duration of action, option of low dose (5mg) daily, (maintains oxygenation thus improving endothelial smooth muscle health)
  3. Vardenafil: 'Levitra', shorter duration of action

24

Other drug/physical approaches to ED treatment?

  • Alprostadil injected into c.cavernosa
  • Bimix
  • Trimix
  • ED shock wave theray 
  • Vacuum device
  • Surgery

These can lead onto other issues!

25

What is rapid (premature) ejaculation?

When ejaculation occurs before the individual wants it to! (subjective)

 

 

26

What are the traditional theories and responses to rapid/premature ejaculation

Traditional Theories: 
-furvitive early masterbation
-too exciting vagina
-Genital hypersensitivity
-lack of alarm signal

 

Traditional therapeutic responses
-sensate focus with 'squeeze' technique
-Stop-start technique
-local anathestic spray

 

not that legit

27

Neurobiological approach to erectile dysfuntion

Selective serotonin reuptake inhibitors (SSRIs) which are antidepressants (increase serotonin levels) have proven to cause delayed ejaculation.

found via experimental evidence of
-decreased serotonin neurotransmission
-hypo function of 5-HT2c receptors
-Familial aspects

By flooding the underfunctioning receptors with serotonin via SSRIs daily

28

Drug treatment for premature ejaculation

  • Dapoxetine (priligyTM) 30mg or 60mg: main drug on the market, quickly metabolised!
  • SSRI's daily or clomipramine daily or 12 hours before sex

29

Delayed (retarded) ejaculation

Definition unclear.

Generalised or situational

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

Attributed to fear, anxiety, hostility and relationship difficulties

Contemporary theory: Waldinger's Ejaculation Distribution Theory (EDT), bell curve

30

Causes of Delayed Ejaculation

  1. Hypofunction of 5-HT1A receptors
    -and/or hyperfunction of 5-HT2c receptors
    -Treament research into 5-HT1A receptor agonists
  2. Acquired DE
    -Psychological
    -Some disease states: neurological condition
    -Meds: SSRIs, tricyclic ADs, antipsychotics