Flashcards in Sexual Med Deck (73)
what are the 5 main stages/phases of sex/sexual arousal?
what sexual problems can affect the drive phase of sex?
what sexual problems can affect the desire/libido phase of sex?
hypoactive sexual desire disorder (HSDD)
what sexual problems can affect the excitation phase of sex?
female sexual interest/arousal disorder
what sexual problems can affect the orgasm phase of sex?
ejaculatory problems e.g. delayed, rapid, retrograde
what are the sexual pain disorders?
dyspareunia (superficial or deep)
what blood tests might be done as part of assessing sexual problems? what kind of problem would prompt you to do each one?
- fasting glucose, lipid ratio = diabetes, CVD - useful to rule in most sexual problems
- testosterone, SHBG, albumin = desire disorders, arousal disorders, orgasmic disorders, pain disorders
- prolactin = desire disorders, ED
- TSH = desire disorders, rapid ejaculation
- oestrogen = female sexual arousal disorder, orgasmic disorder
- FBC = desire disorders, orgasmic disorders
what is hypoactive sexual desire disorder?
lack/loss of sexual desire - not secondary to other difficulties (E.g. dyspareunia, ED).
doesn't preclude enjoyment or arousal, but make initiation of sexual activity less likely.
give some physical causes of HSDD
chronic medical conditions:
- androgen deficiency
- hypogonadism (various causes)
- androgen deficiency
- post pregnancy
give some iatrogenic causes of HSDD in men/women
- prescribe medication e.g. antidepressants, finasteride
- post surgical e.g. orchidectomy
- medication e.g. oral contraceptive, oral HRT, tamoxifen (all bind with testosterone); antidepressants and antipsychotics; beta blockers
- post surgery e.g. bilateral oopherectomy
give some psychological causes of HSDD
- psych conditions e.g. depression, anxiety, substance misuse
- psychological experiences e.g. environmental, life events (work stress), prev trauma/abuse
- body image disorder
- couple's script problems
- erotic dissatistfaction
- couple relationship problems
list some psychosexual treatment modalities
- integrative = combines psychosexual options and physical treatments
- cognitive = e.g. addresses unhelpful thinking styles
- behavioural = e.g. Sensate Focus or Self Growth Programme
- CBT = combines the two
- Psychodynamic = e.g. for past events, attachments, partner choice etc
- Systemic e.g. individual, couple, family dynamics
explain role of testosterone replacement in treating HSDD
- do repeat testosterone tests
- replacement can be given via injection, transdermal patches/gel, buccal, SC implants
- HCG can be used as an alternative to testosterone
describe the use of individual psychosexual therapy for HSDD
- sexual education
- encourages vocalising and accepting difficult feelings
- normalising and permission giving
- finds new solutions for old problems
- surmount barriers to psychological intimacy
- expand communication
- lessen performance anxiety
- transforms destructive attitudes that interfere with intimacy
what is the "Sexual Growth Programme"?
an individual behavioural intervention used in treatment of HSDD.
- allows pt to be aware of their own sexual needs through self exploration of physiological responses
- work w/ therapist to understand and overcome negative beliefs and unhelpful thinking patterns
define erectile disorder (ED)
"difficulty in developing or maintaining an erection suitable for satisfactory intercourse"
can be in obtaining or maintaining erection, or decrease in rigidity
list some physical causes of ED
- chronic medical conditions e.g. CVD, DM, neuro disease
- hormonal - androgen deficiency, high prolactin
- iatrogenic - post prostate surgery, drugs (antiHTNs, antidepressants esp SSRIs)
- age related changes
- ineffective sexual stimuli
- veno-occlusive disorder
list some psychological causes of ED
- psych conditions e.g. depression, substance misuse
- performance anxiety, life events, negative prev experiences
- couple's script problems
- relationship problems, issues from prev relationship
- educational matters
- cultural and religious matters
list some medical treatment options for ED
oral - sildenafil (viagra), avanafil (spedra), tadalafil (cialis), vardenafil (levitra)
injectable - alprostadil (intra cavernosal injection, ICI)
intraurethral - aprostadil MUSE pellet (medical urethral system for erection), alprostradil cream (vitaros)
what patient education advice would you give to someone started on medical treatments for ED?
- need sexual stimulation to work
- work best taken on empty stomach
- need to wait 45-60 mins before sexual activity (only 20-30mins on avanafil)
- efficacy improves from first dose to eighth
watch for unacceptable ratio of benefits to side effects.
need partner support
may have difficulty incorporating into sexual script
what are some non-medical treatment options for ED?
- vacuum device
- penile/scrotal rings
- new stimulating routines e.g. enhancing lubes, vibrators
- Kegel exercises
what are the criteria for prescribing medical treatments for ED on the NHS?
can prescribe sildenafil universally, but for others:
i. Have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida or spinal cord injury.
ii. Are receiving dialysis for renal failure.
iii. Have had radical pelvis surgery, prostatectomy (including transurethral resection of the prostate), or kidney transplant.
iv. Were receiving Caverject, Erecnos, MUSE, Viagra or Viridal for erectile dysfunction at NHS expense on/before 14 September 1998.
v. Are suffering severe distress as a result of impotence (prescribed in specialist centres only)
- psychological treatments - individual sexual and/or couple therapy - expensive!
what is female sexual arousal disorder?
lack of/reduced/failure of genital response - principle issues is vaginal dryness or failure of lubrication
DSM also included reduced interest in sex, reduced erotic thoughts/fantasies etc
give some physical causes of female sexual arousal disorder
- chronic medical conditions - CVD, DM, neuro disease, connective tissue disease
- hormonal disorders - oestrogen deficiency (e.g. post menopause), thyroid disorders
- iatrogenic - prescribed meds (e.g. antidepressants)
vaginal dryness is often presenting problem - can be caused by local irritants and douching
list some psychological causes of female sexual arousal disorder
- psych conditions e.g. depression, anxiety, binge eating disorders, excessive dieting
- prev abuse
- couple script problems
- decreased intimacy
- couple's relationship problems
what is the role of couple psychosexual therapy for treating female sexual arousal disorder?
elements are similar to those used in individual options
hierarchy of interventions:
- addressing intimacy
- being sexual
- adjusting to difficulties
describe behavioural interventions that might be used for female sexual arousal disorder
- staged programme of exercises - helps couple identify their own likes/dislikes, explore new techniques
- work w/ therapist to understand and overcome negative beliefs/thinking patterns
New sexual routines, lubricant, vibrators, vielle (device worn on fingers)
Eros therapy device:
what is the Eros therapy device?
- small handheld device used at home
- proven treatment for arousal and orgasmic disorders
- greater clitoral/genital engorgement
- increase vaginal lubrication
- enhanced ability to achieve orgasm
- improved sexual satisfaction
describe a "level 1" couple presenting to sexual medicine clinic
the ideal couple!
high quality relationship, continuing to be affectionate, maintaining non-coital play.
realistic expectations re treatment.
value return of satisfying sex life.
treatment - will usually only require medical intervention and succinct advice.
must follow up though!