Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynaecology > Sexual Health And Sexual Dysfunction > Flashcards

Sexual Health And Sexual Dysfunction Flashcards

(71 cards)

Start Studying
1
Q

What is hypoactive sexual desire disorder (HSDD)?

A

It presents with loss of libido and decline in sexual desire.
It affects personal relationships and causes distress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of HSDD?

A 
Psychosexual (majority)
Menopause
Depression
Chemotherapy
Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are important questions to ask in patients with possible HSDD?

A

When it started, normal sexual function, realistic and at odds with sexual partner? Relationship problems?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for HSDD?

A

Psychosexual counselling

Testosterone supplementation may help (especially if symptoms followed oophorectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are they causes of superficial dyspareunia?

A

Infections

Skin conditions like lichen sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can superficial dyspareunia be treated?

A

Treat the underlying cause
But pain can start a cycle of fear, anticipation and avoidance
Lubricants and local anaesthetics can help to break the cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is vaginismus?

A

Difficulty of the woman to allow vaginal penetration despite wanting to
It involves involuntary contraction of the pelvic floor muscles an adductors
It is a symptom/sign, but not a diagnosis
Usually precipitated by another cause - physical/psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When suspecting vaginismus what should first be excluded?

A

Anatomical problems like vaginal septae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the management for vaginismus?

A

Vaginal dilators may alleviate the pubococcygeal reflex

Encourage the woman to use her own fingers in combination with some relaxation exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is vulvodynia?

A

A burning pain occurring in the absence of visible findings/a clinically identifiable neurological disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for vulvodynia?

A

MDT approach with physio, psychosexual medicine and pain management
First line treatment: pelvic floor exercises, internal and external perineal massage, topical anaesthetic
Tricyclic antidepressants and gabapentin may also work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the general management for sexual dysfunction?

A

Lifestyle: diet, exercise, stress reduction, exploration of relationship problems/body image issues
Education: body function, encourage exploration, sexual education material, lubricants
Hormonal: oestrogen replacement in menopausal women, testosterone if oophorectomy and HSDD
Behavioural therapy
Devices: e.g. for anorgasmia or vaginismus such as dilators or clitoral stimulators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the key symptoms to ask about in the sexual history for a woman?

A 
Genital skin changes
Vulval itching or soreness
Dysuria
Abnormal vaginal discharge
Abnormal vaginal bleeding
Dyspareunia
Abdominal/pelvic pain
Systemic symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are important questions to ask about vaginal discharge?

A

Volume
Colour - including if it was blood-stained
Consistency - thickened or watery
Smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which STIs cause abnormal vaginal discharge and what are the characteristics of each?

A 
Gonorrhoea
Chlamydia
Bacterial vaginosis 
- offensive, fishy-smelling discharge
- no soreness or irritation
Trichomonas vaginalis
- yellow, frothy discharge
- associated with vaginal itching and irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the different types of vaginal bleeding and what are the causes of each?

A

Post-coital bleeding
- infection, cervical ectropion, cervical cancer
Intermenstrual bleeding
- infection, cervical/endometrial cancer, uterine fibroids, endometriosis, hormonal contraception, pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the causes of dyspareunia?

A

STIs, endometriosis, vaginal atrophy, malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the different types of dyspareunia?

A

Superficial - e.g. genital herpes

Deep - e.g. gonorrhoea, chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are important questions to ask about dyspareunia?

A

Do you experience pain around the time of having sex?
How long does it last?
When does it occur? (Before, during or after)
Is the aim on the surface and in the vagina or more deep?
Nature of the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for STIs?

A 
Unprotected sexual intercourse
Multiple sexual partners
15-24 year olds
Illicit drug and alcohol use
MSM
Sex workers
Urba areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the causative organism for chlamydia?

A

Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is chlamydia transmitted?

A

Obligate intracellular bacteria - predominantly transmitted via sexual contact
Also perinatal transmission from mother to baby during vaginal deliver - can lead to neonatal conjunctivitis and pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the presentation of chlamydia?

A

Asymptomatic in over 80% of cases
Males - mucupurulent discharge, dysuria, scrotal pain, proctitis
Females - mucupurulent vaginal discharge, cervicitis, cervical bleeding upon contact, proctitis, point-coital bleeding, IMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the diagnostic investigations for chalmydia?

A

NAAT - first pass urine in males; vulvovaginal swabs in females
Oropharyngeal and rectal sites can also be swabbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the management for chlamydia?
Azithromycin 1g oral single dose/ Doxycycline 100mg oral BD for 1 week (favoured if proctitis present)/ Erythromycin 500mg oral BD for 2 weeks Contact tracing and partner notification need to be offered All forms of sex should be avoided until both parties tested and treated
26
What are the complications of chlamydia?
PID - increases risk of ectopic pregnancy and infertility Epididymitis Prostatitis Reactive arthritis
27
What is lymphogranuloma venerum?
Caused by a more invasive stereotype of chlamydia trachomatis Causes a triad of inguinal lymphadenopathy, proctocolitis and fever
28
What is the causative organism of gonorrhoea?
Neisseria gonorrhoeae
29
How is gonorrhoea transmitted?
Predominantly via sexual contact Mucosal epithelium lining the genital tract, orophraynx and rectum are commonly affected Transmission during childbirth can cause gonococcal conjunctivitis which has an earlier onset than chalmydial conjunctivitis
30
How does gonorrhoea present?
Males - mucopurulent urethral discharge, dysuria, orchitis Females - mucopurulent cervical discharge with cervicitis, cervical bleeding upon contact, dyspareunia, pelvic pain Rectal infection - rectal bleeding, rectal discharge, tenesmus, proctitis Oropharyngeal infection - pharyngitis, anterior cervical lymphadenopathy
31
What are the investigations for gonorrhoea?
NAAT - first pass urine in males/vulvovaginal swabs in females Oropharyngeal and rectal sites can also be swabbed Cultures taken prior to administering antibiotics to assess antibiotic susceptibility
32
What is the management of gonorrhoea?
Ceftriaxone 500mg IM single dose + Azithromycin 1g oral single dose Contact tracing and partner notification Avoid intercourse until tested and treated Test of cure 2 weeks after treatment using NAAT
33
What are the complications of gonorrhoea?
PID - increased ectopic pregnancy and infertility risk Fitz-Hugh-Curtis syndrome - secondary to PID there is inflammation of the hepatic capsule leading to perihepatic adhesions Chronic pelvic pain in females Infertility in males secondary to epididymitis Prostatitis Bartholinitis
34
What is the causative organism for syphilis?
Treponema pallidum (sphirochete bacterium)
35
How is syphilis transmitted?
Sexual contact with an infected person who has a lesion on the skin/mucosa Congenital syphilis occurs as a result of trans-placental transmission which increases the risk of stillbirth/miscarriage
36
Describe the 1st stage of syphilis.
``` Primary syphilis Development of an induration painless ulcer (chancre) Forms most often on the genitals Can form from 9-90 days Most infectious ```
37
Describe the 2nd stage of syphilis.
Secondary syphilis 6 weeks to 6 months following primary infection Widespread non-pruritic maculopapular rash involving palms and soles Accompanied by Alopecia, condylomata lata, generalised lymphadenopathy, oral snail-track lesions and systemic symptoms Most infectious
38
Describe the 3rd stage of syphilis.
Early latent | Asymptomatic infection + positive diagnostic serology obtained within 2 years of infection
39
Describe the 4th stage of syphilis.
Late latent | Asymptomatic infection + positive diagnostic serology after 2 years of infection
40
Describe the 5th stage of syphilis.
Tertiary syphilis Untreated syphilis over many years Can develop into neurosyphilis/cardiovascular syphilis/gummatous syphilis
41
What are the diagnostic investigations for syphilis?
Dark ground microscopy of chancre fluid (motile, spring-shaped bacteria in primary) Syphilis PCR - swab taken from ulcerated lesion Treponemal-specific serology remains positive throughout life (EIA, TPHA, TPPA) Cardiolipin serology tests to measure disease activity, disease staging and treatment efficacy (RPR, VDRL)
42
What is the management for syphilis?
Benzathine benzylpenicillin IM single dose + Prednisolone PO for 3 days (Comice 24hrs before penicillin given) Contact tracing and partner notification
43
What are the complications of syphilis?
Jarisch-Herxheimer reaction (antibiotic treatment of syphilis causes a sepsis-like picture due to release of toxins from treponemal bacterial breakdown which is why steroids are administered before to prevent this) HIV co-infection
44
What are the causative organisms of herpes?
HSV-1 and 2
45
How is herpes transmitted?
Transmitted through mucosal surfaces or broken skin HSV-1 (oral herpes) - spread via oral-oral route, but can also affect the genital HSV-2 (genital herpes) - sexually transmitted and affects the genital and anal areas It is a lifelong infection as it stays dormant within the sensory ganglia causing intermittent reactivation The virus is transmitted even if asymptomatic (asymptomatic shedding)
46
How does herpes primary infection present?
Multiple painful blisters erupt around genitals/mouth Burst to leave ulcers/fissures Accompanying dysuria, pyrexia, painful inguinal lymphadenopathy, neuropathic pain around external genitalia Can last up to 3 weeks Recurrent infections only last around 3 days and tend to have milder symptoms
47
What are the diagnostic investigations for herpes?
HSV PCR/culture from swabs taken from lesions (burst the lesion and swab the base)
48
What is the management of herpes?
Primary episode - aciclovir 400mg PO TDS for 7-10 days (should be commenced within 3 days of symptom onset) Recurrent episodes -800mg PO TDS for 2 days Salt water baths, oral analgesia, topical lidocaine
49
What are the complications of herpes?
Urinary retention HSV keratitis - dendritic lesion on the cornea Aseptic meningitis Neonatal HSV (increased risk if the mother becomes infected in the third trimester) Herpetic whitlow
50
What are the causative organisms of genital warts?
HPV 6 and 11
51
How are genital warts transmitted?
Direct skin to skin contact | Many carry the virus, but not all develop genital warts
52
How does genital warts present?
Warts can vary in size, colour and texture Mostly appear around the vaginal opening and penis (these areas are most exposed to friction) The anus, cervix and urethral meatus can also be affected Predominantly genital warts are asymptomatic, but itching, bleeding and pain can occur
53
What are the diagnostic investigations for genital warts?
Diagnosis is clinical | Biopsies should be obtained if the lesion bleeds/is ulcerated/indurated
54
What is the management for genital warts?
First line - topical podophyllotoxin (non-keratinised) - topical imiquimod (keratinised) Second line - cryotherapy/surgical excision
55
What are the complications of genital warts?
Anogenital cancer | Scarring following treatment
56
What is the causative organism of trichomoniasis?
Trichomonas vaginalis (flagellated Protozoa)
57
How is trichomoniasis transmitted?
Via sexual intercourse
58
How does trichomoniasis present?
Asymptomatic in >50% Females: vaginal discharge (thin, frothy yellow-coloured discharge with a ‘fishy’ smell), vulval pruritis, vulvovaginitis, dysuria, dyspareunia Males: urethral discharge, dysuria, balanitis
59
What are the diagnostic investigations for trichomoniasis?
Vaginal pH - alkaline (>5) High vaginal swab for wet mount microscopy Culture of vaginal discharge Men - culture of urethral swab/first pass urine
60
What is the management for trichomoniasis?
Metronidazole 2g PO single dose Contact tracing and partner notification All forms of sex should be avoided until both parties are tested and treated
61
What are the complications of trichomoniasis?
PID - ectopic pregnancy and infertility Altered vaginal fora Prostatitis Increased risk of premature rupture of membranes and preterm birth in pregnancy
62
What is HIV and how does it affect cells in the body?
It is a single-stranded RNA retrovirus that infects and replicates within the human immune system using host CD4 cells
63
What is AIDS?
Acquired immune deficiency syndrome When HIV is not treated - there is destruction of the immune system Characterised by the development of certain (AIDS-defining) infections and malignancies e.g. pneumocystis jiroveci, pneumonia, non-Hodgkins lymphoma, TB.
64
Describe how HIV infects the CD4 cell.
Penetrates the CD4 cell and empties its contents. SsRNA converted to dsDNA by reverse transcriptase. Combined with the host DNA using integrase. When the infected cell divides, the viral DNA is read, creating viral protein chains and the immature virus pushes out of the cell, retaining some cell membrane. The virus matures when protease cuts the viral protein chains and they assemble to create a working virus. The host cell is destroyed during this process.
65
Describe the stages in an HIV infection.
Upon seroconversion (the process of producing anti-HIV Abs during primary infection), the patient may experience flu-like symptoms. CD4 levels fall in response to the initial, rapid replication of HIV. The patient is extremely infectious at this stage. Latent phase - over the next few months/years. Initially asymptomatic, but then more susceptible to infections with CD4 levels falling and viral load increasing. The HIV infection can then later be symptomatic. Over an average of 10 years, can develop into AIDS.
66
How is HIV transmitted?
Unprotected sexual contact - vaginal/oral/anal Sharing of injecting equipment Medical procedures (blood products, skin grafts, organ donation) Vertical transmission (during childbirth/breast feeding)
67
What factors make a person more likely to catch HIV?
Exposure to a higher viral level STI causing anogenital inflammation Breaks in the skin/mucosa
68
Who are the at risk groups for HIV?
MSM IV drug users In high prevalence areas Unprotected sex with someone who has lived or travelled to Africa
69
The clinical features of HIV can be split into initial seroconversion illness and symptomatic HIV. What are the features of the initial seroconversion illness?
``` 2-6 weeks after exposure Non-specific, flu-like illness (fever, muscle aches, malaise) Lymphadenopathy Maculopapular rash Pharyngitis ```
70
What are the features of symptomatic HIV and how does it develop?
Months to years after the seroconversion illness, the infection can enter a latent, asymptomatic phase. After this the infection will become symptomatic. Weight loss, high temperature, diarrhoea Frequent motor opportunistic infections e.g. herpes zoster, candidiasis
71
What are the investigations that are done for HIV?
Fourth generation tests are 1st line (ELISAs test for serum/salivary HIV Abs and p24 antigen) - give reliable results 4-6 weeks after exposure Other rapid test kits and at home kits give results in 30 mins but are not as accurate and still need confirming with ELISA if positive.

Gynaecology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions