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Obs and Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

(60 cards)

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1
Q

Define dysuria and dyspareunia

A

Dysuria - painful/burning on peeing

Dyspareunia - difficult or painful sexual intercourse

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2
Q

What is erectile dysfunction

A

Persistent inability to attain and or maintain and erection

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3
Q

Causes of erectile dysfunction

A

Vasculogenjc (CVD, HTN, HYPERLIPIDAEMIA, DM, SMOKING)
Neurogenic (MS, Parkinson, stroke, cKD, polyneuropathy)
Hormonal (hypogonadism causing low testosterone, hyperprolactinaemia , hyper / hypothyroidism , Cushings

Drugs - anti hypertensives (beta blockers, verapamil, clonidine), diuretics (spironolactone, thiazides), antidepressants, corticosteroids, ranitidine, marijuana, alcohol

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4
Q

Erectile dysfunction diagnosis

A

History

Morning total testosterone (highest in morning, so even if borderline normal in morning, it’s a problem)

If total serum testosterone borderline normal, tests free testosterone with FSH, LH and prolactin then refer to endocrinology for more tests

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5
Q

Erectile dysfunction management

A

Refer to urology if abnormality found on physical exam or if young patient

Refer to endocrinology if abnormal hormone levels

PDE 5 inhibitor (phosphodiesterase inhibitor) - sidenafil, tadalafil, vardenafil, avanafil - regardless of suspected cause unless they have a high cardiovascular risk

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6
Q

Possible causes of premature ejaculation

A

Prostatic is, thyroid disease or psychological distress

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7
Q

Premature ejaculation management

A

Psychosexual counselling
Topical anaesthetic
Dapoxetine (SSRI) as this causes delayed orgasms as a side effect - take 1-3 hrs before sexual activity

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8
Q

Causes of decreased libido

A

Low testosterone
Hypothyroidism
Anxiety/depression
SSRIs and SNRIs
Recreational drug use

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9
Q

What is anorgasmia

A

Persistent or recurrent delayed, infrequent or absent orgasms

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10
Q

Causes of anorgasmia

A

Neurological disorders, previous gynae surgery’s, medications (SSRIs or diuretics), alcohol or smoking, psychological problems

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11
Q

Management of anorgasmia

A

Treat underlying cause
Psychosexual counselling

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12
Q

Define Vaginismus

A

Involuntary contraction of vaginal musculature - can cause pain during vaginal penetration (gynae exam, tampon insertion or sexual intercourse)

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13
Q

Vaginismus causes

A

Psychological - prev sexual trauma

Vestibulodynia (tender at entrance of vagina) e.g. in post menopausal women due to oestrogen deficiency or due to previous genital surgery or skin disorders

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14
Q

Vaginismus presentation

A

Dyspareunia
Vagina, dryness
Inability to use tampons
Anorgasmia
History of previous trauma examination or sexual experience

May physically have signs of scarring or inflammation or entrance

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15
Q

Vaginismus management

A

Vaginal trainers
Psychosexual therapy
Topical lidocaine
Hormone replacement therapy for post hysterectomy, peri or post menopausal women
Pelvic floor exercises

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16
Q

Define atrophic vaginitis

A

Volvo vaginal atrophy, drying, inflammation secondary to declining oestrogen in peri or post menopausal women

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17
Q

Atrophic vaginitis presentation

A

Dyspareunia
Light bleeding following intercourse
Vaginal dryness/burning
Vaginal discharge
Pruritus vulvae - itchy vulva
Dysuria
Urinary urgency and incontinence
Polyuria
Recurrent UTIs

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18
Q

Atrophic vaginitis diagnosis and management

A

Pelvic examination
urinalysis to rule out UTI

Vaginal moisturisers
water based lubricants to use prior to sexual activity
Topical oestrogen - for menopausal atrophic vaginitis - used short term

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19
Q

Define oligozoospermia, asthenozoospermia and teratozoospermia

A

Oligozoospermia - low sperm count
Asthenozoospermia - reduced sperm motility
Teratozoospermia - high amount of abnormal shaped sperm

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20
Q

Define infertility

A

Failure to conceive after frequent unprotected sexual intercourse for at least one year

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21
Q

Causes of infertility

A

Sperm abnormalities
Ovulating disorders e.g. PCOS, premature menopause
Tubal damage from PID
Uterine or peritoneal disorders e,g, fibroids

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22
Q

Female infertility assessment

A

Serum mid-luteal phase progesterone - to confirm ovulation
Chlamydia testing for PID
Serum FSH and LH
Thyroid function tests
Serum prolactin

Hysterosalpinography (x ray that looks inside uterus and fallopian tubes to see if there is partial or full blockage) or ultrasonography

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23
Q

What to ask in history to check for female infertility

A

Length of time trying to conceive and sexual intercourse frequency
Menstrual cycle details
Galactorrhoea or hirsuitms
Thyroid dysfunction or diabetes

Symptoms for PID or endometriosis
History of STIs
Smoking and alcohol consumption

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24
Q

Male fertility assessment

A

Semen analysis - repeat if abnormal
Chlamydia testing

Imagining of urogenital tract
Testicular biopsy
Endocrine tests

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25
Things to ask in history to test for male infertility
Length of trying to conceive and frequency of sexual intercourse History of mumps (causes orchitis (inflammation of testes) is resulting in permanent damage for sperm production) STIs Testicular trauma or torsion Prev abnormality or surgeries e.g. undescended testes Erectile dysfunction
26
What clinical findings on physical examination may you find in male infertility
Penile structure Abnormalities (hypospadias - opening of urethra on underside) Scrotal examination - varicocle, hernia or undescended testes Signs of hypogonadism (small tests, gynaecomastia, decreased body hair)
27
Infertility management
Advice - regular intercourse every 2-3 days, take folic acid, smoking cessation and healthy body weight Refer - medicine (clomifene for women who don’t ovulate), surgery, assisted conception (IVF or intrauterine insemination - IUI)
28
What is chlamydia and how is it transmitted
Genital infection caused by BACTERIUM CHLAMYDIA TRACHOMATIS Transmitted via contact with infection secretions / fluids
29
Symptoms depending on where infection is and clinical signs of chlamydia and PID
urethral / cervical infection - Purulent vaginal discharge, dysuria, post coital / inter menstrual bleeding Deep dyspareunia and pelvic pain if PID Anorectal infection - Anorectal discomfort and discharge Penile urethral - dysuria, urethral discharge and painful ejaculation Clinical signs - inflamed friable cervix and discharge , testicular pain, swelling and tenderness
30
Chlamydia management
Refer to GUM clinic Begin treatment if symptoms strong without waiting for results Doxycycline 100mg BD 7days Avoid sexual intercourse until pt and their sexual partner have completed treatment Screen for other STIs
31
What is gonorrhoea, how is it transmitted
STI caused by bacterium NEISSERIA GONORRHOEAE
32
Complications of gonorrhoea
Epidemic-orchitis Prostatic is Penile urethral structure Male infertility PID Perihepatic abscess Reactive arthritis
33
Gonorrhoea symptoms and clinical signs - depending on where infection is - penile, anorectal, pharyngeal, cervical
Penil - discharge, dysuria and testicular pain or swelling Anorectal - discharge, anal pain, rectal bleeding, tenesmus, pain on DRE Pharyngeal - sore throat, asymptomatic - may have tonsillar exudate, erythema Cervical - symptoms within first 10 days - abnormal vaginal discharge, inter menstrual bleeding, friable cervix, may have dyspareunia or lower abdominal pain (PID)
34
Gonorrhoea diagnosis
Refer to GUM clinic NAAT tests on swabs or for penile first catch urine , culture and density and screen for other STIs
35
Gonorrhoea management
Refer to GUM clinic Obtain culture then start antibiotics - ceftriaxone if culture pending or ciprofloxacin if sensitive on culture result) Abstain from sex for 7 days until them and partner treated Test if cured 1 week after treating
36
Define HPV and how is it transmitted
Human papillomavirus- viral aetiology of warts Transmitted via skin to skin contact or with genital secretions
37
HPV symptoms
Skin growth of anogenital or oral regions (verruca (cauliflower like growth under 10mm) - may be irritation, itchy if bleeding Wart is mostly raised, attached to skin and pigmented or skin coloured
38
HPV diagnosis
Clinical diagnosis Biopsy if atypical and screen for other STIs
39
HPV management
Refer to sexual health Use condoms and smoking cessation advice Screen partner - they may not have transmitted it to pt as latency period is 3wks to 8 months Cryotherapy, excision, electrocautery of warts Podophyllotoxin solution, imiquimod cream, sinecatechins ointment - may taken 1-6 months for efficacy but if no response after 4-5 weeks change treatment
40
What is HSV genital and how is it transmitted
Herpes simplex virus Genital infection caused by HSV1 or HSV2 through direct contact of mucosal surfaces or break in skin with infection secretions (HSV1 spreads orally or genitally but HSV2 only spreads via genital contact)
41
Primary HSV infection presentation
Clustered painful erythematous vesicles Fever Malaise Headache Dysuria if breakout is in penile area Tender inguinal lymphadenopathy Vaginal /urethral discharge Tingling in genital area Lasts up to 3 weeks
42
Recurrent HSV infection presentation
Clustered painful erythematous vesicle within same dermatology as primary outbreak Burning up to 48 prior to vesicles appearing Not as many systemic symptoms as primary infections (fever etc…) Lasts 6-12 days
43
Genital HSV diagnosis and advice and management
Swab lesions for HSV viral PCR Avoid sex if lesions present and transmission possible with infected lesions e.g. on bed sheets and linen After lesions gone, must use condoms as transmission can occur when asymptomatic Refer to sexual health service Oral antiviral (aciclovir or valciclovir) within 5 days of start of episode If more than 6 recurring episodes in a year give daily aciclovir, valaciclovir or famciclovir to suppress for a year then increase dosage if symptoms come back
44
What is trichomoniasis and how is it transmitted
STI caused by flagellated protozoan Trichomonas vaginalis Transmitted only through sexual intercourse
45
Trichomoniasis diagnosis
Vaginal swab pH testing - if higher than 4.5 suggestive Gram staining via high vaginal swab If urethral infection - first catch urine and culture / microscopy
46
Trichomoniasis management
Oral metronidazole Treat sexual partners of within 4 weeks before presentation Screen for other STIs Avoid sex until treatment of pt and partner completed
47
What is syphilis and how is it transmitted
Infection caused by sporophyte bacterium TREPONEMA PALLIDUM Transmitted via direct contact with infectious lesion, mother to child during pregnancy or by needle sharing
48
Primary syphilis presentation
Chancre- painless ulcer develops at site of inoculation within 90 days of infection and resolves by itself after 3-10 weeks Localised lymphadenopathy
49
Secondary syphilis presentation
4-12 weeks after chancre symptoms appear Non pruritic rash on palms and soles of feet Condyloma Lara (moist grey white wart like lesions in areas of friction like vulva, breast or axillae) Snail tract lesions - patchy oral mucosa lesions Alopecia
50
How does latent syphilis present
Asymptomatic in early and late latent syphilis Tertiary syphilis - presents 10-30 yrs after initial infection - gummatous syphilis, cardiovascular syphilis or neuro syphilis Gummatous syphilis- granulomatous lesi9ms with necrotic centre Cardiovascular syphilis- aortic regurgitation, aortic aneurysm or heart failure Neuro syphilis - paresthesia, absent reflex
51
Syphilis diagnosis
Refer to GUM specialist Treponemal tests (detects IgG and IgM for bacteria that causes syphilis) Dark field microscopy or PCR swab of chancre Lumbar puncture for CSF testing (for bacteria) if suspecting neuro syphilis
52
Syphilis management
Screen other STIs and contact trace Intramuscular benzathine benzylpenicillin IV aqueous benzylpenicillin if neuro syphilis
53
What is HIV and how is it transmitted
Human immunodeficiency virus - RNA retrovirus - infects and destroys CD4 T helper cells Contact with bodily fluids - blood, semen, vaginal secretions, breast milk or amniotic fluid
54
How is AIDs defined
CD4 count less than 200 cells / uL
55
Acute HIV infection presentation (symptoms and clinical signs)
Fever, malaise, myalgias, sore throat, headache, night sweats, lymphadenopathy, rash, diarrhoea, mouth sores Lymphadenopathy Maculopapular rash Aphthous ulcerations
56
Chronic HIV presentation
Fever, weight loss, night sweats, lymphadenopathy, chronic diarrhoea Recurrent treatment resistant infections - shingles, candidiasis, seborrheic dermatitis, skin infections Opportunistic infections and malignancies (Kaposi’s sarcoma)
57
AIDs defining illnesses
Candidiasis of lungs or oesophagus TB Kaposi’s sarcoma HIV related lymphoma
58
When to test for HIV
Consider testing if sever, recurrent symptoms and infections Persistent lymphadenopathy Conditions related to immunosuppression (candidiasis and shingles) Glandular fever like illness Unintended weight loss of over 10 kg Risk factors for HIV Diagnosed with STI Pregnant
59
HIV diagnosis
Depends on window period Serum HIV RNA PCR - viral load - early detection but may show false negative if too early - for suspected acute HIV infection HIV antibody and p24 antigen test - accurate after 4 weeks of infection Rapid tests - finger prick or mouth swab - accurate 3 months after infection so may show false positives earlier as it’s looking for HIV antibodies - quick results in 5-10 mins
60
HIV management and its side effects
Refer to GUM clinic if new diagnosis Antiretroviral (ART) medications Monitor serum CD4 count and HIV RNA PCR (viral load).- aim for undetectable viral load (less than 20 / uL) Side effects if ART - diarrhoea , fatigue, renal dysfunction, liver toxicity, glucose intolerance, hyperlipidaemia

Obs and Gynae (8 decks)

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