Sexual Health Flashcards
(27 cards)
What is gender dysphoria and how is it assessed?
Disorder of gender identity - desire to live as opposite sex.
Hx of 2 years transsexual identity with full psych hx - gender development, sexual hx
Rx for gender dysphoria?
Referral to gender clinic, real life testing for 1 year
Hormone therapy (synthetic oestrogen, testosterone)
Gender reassignment surgery eg penectomy, vaginoplasty, hysterectomy
Investigations for sexual disorder?
Full sexual hx, examination
Blood tests: fasting glucose, lipids, testosterone, SHBG (sex hormone binding globulin), prolactin, TSH, Oestrogren, FBC, GnRH
Psychological treatments for sexual disorders?
CBT, psychodynamic (past events, attachments, partner choice), systemic (interactions and roles in relationship), Integrative (combination)
What is hypoactive sexual desire and what causes it?
Lack of/loss of sexual desire causing destress - doesn’t preclude enjoyment
Cause: chronic disease (DM, CVD, anaemia, obesity), hormonal (androgen deficiency, hypothyroid), iatrogenic (SSRI, OCP, surgery), psychiatric (depression, anxiety)
Rx for hypoactive sexual desire disorder?
Psychosexual - CBT, psychodynamic, integrative).
Medication - testosterone = M, Flibanserin = F
What is erectile dysfunction and what causes it?
Difficulty in developing/maintaining an erection suitable for sexual intercourse. With adequate stimulation.
Cause: chronic medical condition (CVD, DM, Neuro, BPH), hormonal deficiency - testosterone, high prolactin - prolactinoma, Iatrogenic (prostate sx, SSRI, opiates) psychiatric (depression, stress, anxiety)
Peyronie’s disease
Partner: relationship issues, conflict, if they have a sexual problem - man doesn’t want to hurt partner w/vaginismus
ED investigations and Rx?
Ix: history, bloods: HbA1c, lipids, testosterone + SHBG + albumin, FSH, LH, prolactin, PSA
1st line…
-Phosphodiesterase inhibitors e.g. Sildenafil (viagra)
-S/E=Headaches and flushing
-C/I= Hypotension
Then try w/one of others = tadalafil/avanofil
2nd line…
-Alprostadil (intracavernosal injectable or intraurethral via MUSE)
NON MEDICAL Vacuum device Penile/scrotal rings Kegel exercises Psychological - personal sexual growth work
What is Female Sexual arousal disorder?
Failure of genital response (vaginal dryness, reduced sexual interest, reduced response to stimuli)
Causes of female sexual arousal disorder?
Disease (DM, CVD, neuro)
Hormonal - oestrogen deficiency - menopause
Iatrogenic - SSRI
Psychological
Rx for female sexual arousal disorder?
Behavioural: sensate focus, Eros therapy device, lubricants
Psychosexual couples therapy
What is rapid ejaculation and what causes it?
Inability to control ejaculation sufficiently for both partners to enjoy sexual interaction - under 1 min
Hyperthyroidism, penile hypersensitivity, psychological - performance anxiety, lack of experience
Rx for rapid ejaculation?
1st line - SSRI - dapoxetine (increased risk of suicide), STUD 100 spray (topical anaesthetic), psychosexual therapy, behavioural - start/stop
What is female orgasmic disorder w/ cause and rx?
orgasm delayed or does not come.
Cause: Chronic disease - DM, CVD, obesity, androgen deficiency, pelvic floor weakness, SSRI, psychological
Rx: topical oestrogens, guided masturbation, vibrators
What is vaginismus and what is cause?
Spasm of pevic floor muscles surrounding vaginal opening making penile entry impossible/painful.
Cause: thrush, FGM, congenital, psychological - tramuam/fear
Rx for vaginismus?
Psychosexual, self exploration, vaginal dilators and graded penetration therapy
What is dyspareunia and what causes?
Pain during intercourse - only when no non-organic dysfunction
Cause: local pathology:
female: deep: PID, entometriosis, gynae (fibroids/cyst), surgery (episiotomy), trauma, radiotherapy
Superficial - lichen sclerosis, STI, episiotomies, vaginal atrophy, anaemia, recurrent UTIs
male - STI, urethral strictures, varicoceles, psychological
Partner issues - check sexual practices
Psych: avoidance, can’t relax, stress, relationship - is she aroused enough/giving enough time.too much time e.g. prolonged ejaculation, body dysmorphia
Ix and Rx for dyspareunia
Ix: Physical exam - bimanual/speculum; bloods: FBC (infection/ANAEMIA), glucose, hormones: oestrogen, testosterone (if symptomatic), FSH, LH, prolactin
Rx: Lubricants, couples therapy/behaviour therapy, kegals exercises
Risk factors and presentation of candida albicans?
Pregnancy, DM, antibiotics.
Pres: cottage cheese discharge, itching, sorenes
Ix and Rx for candida albicans?
Ix: clinical, MC&S - mycelia spores
Rx: clotrimazole cream / PO fluconazole
RF, pres, Ix and Rx of bacterial vaginosis?
RF: Sexual active, IUD, new partner
Pres: 50% symptomatic - white, fishy smelling discharge
Ix: vaginal swab - pH >4.5, clue cells
Rx: metronidazole
Cause, RF, pres of gonorrhoea?
Neisseria gonorrhoea - Gram -ve diplococcus
RF: previous STI, multiple partners
Pre: 90% M and 50% F asymptomatic - white/yellow/green discharge
Ix and Rx for gonnorhoea?
Ix: NAAT (nucleic acid amplification test)
Rx: IM ceftriaxone and PO azithromycin (cover chlamydia)
Cause, RF, Pres, Ix and Rx for chlamydia?
Chlamydia trochomatis, gram -ve
RF: previous STI, multiple partner, PID, Reiters
Pres: 70% F and 50% M asymptomatic - milky white/yellow discharge, dysuria, intermenstrual bleeding
Ix: NAAT, swabs
Rx: PO azithromycin
