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Flashcards in Sexual Medicine Deck (52)
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1

What are the two main features of hypoactive sexual desire disorder (HSDD)?

Lack or loss of sexual desire CAUSING distress - primary prob. Doesn't mean can't have sexual enjoyment or arousal, but makes initiation of sexual activity less likely.

Persistently/recurrently deficient (or absent) sexual/erotic thoughts or fantasies desire for sexual activity.

2

Aetiology of hypoactive sexual desire disorder (HSDD)

Chronic diseases e.g. obesity, CVD, DM, anaemia
Hormonal disorders (androgen defic., hypogonadism, hyperprolactinaemia, hypothyroidism, post-preg, Addison's disease)
Iatrogenic: prescribed meds (SSRIs, finasteride (for BPH), oral contraceptive, HRT, tamoxifen (all of these bind with testosterone), surgery)
Psych (depression, anxiety, substance misuse, prev trauma, relationship probs

3

HSDD treatment options

Psychosexual therapy - CBT, psychodynamic, cognitive, integrative, behavioural
Medication - testosterone replacement (Flibanserin if pre menopausal women)

4

Define erectile dysfunction

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

5

Aetiology of erectile dysfunction

Physiological:
-Chron med conds (CVD, DM, neurological disease)
-Hormonal disorders
e.g. androgen defic., high prolactin
-Iatrogenic e.g. post prostate surgery, SSRIs, HTN
-Age related
-Ineffective sexual stimuli
-Pain
-Veno-occlusive disorder

Psychological:
-Psych conds e.g. depression, substance misuse
-Couples script problems
-Relationship problems or issues from previous relationship
-Educational matters
-Cultural and Religious matters

6

Medication for erectile dysfunction

1st line - phosphodiesterase inhibitors e.g. sildenafil (viagra). S/E: headaches and flushing
2nd line: alprostadil (injectable or intraurethral via MUSE - medical urethral system for erection)

7

Non-medical treatment for ED

Vacuum device
Penile/scrotal rings
New stimulating routines e.g. enhancing lubricants, vibrators
Kegel exercises
Psychological treatment (CBT, integrative, psychodynamic, systemic)

8

Define female sexual interest/arousal disorder (FSAD)

Failure of genital response - main problem is vaginal dryness or failure of lubrication.
Reduced sexual interest/arousal:
Absent/reduced interest in sexual activity
Absent/reduced sexual/erotic thoughts or fantasies
Absent/reduced sexual pleasure
Absent/reduced sexual arousal in response to sexual stimuli

9

Aetiology of FSAD

-Chron med conds e.g. CVD, DM, neurological disease, connective tissue disease
-Hormonal disorders - oestrogen deficiency, e.g. post menopause
-Iatrogenic - SSRIs
-Lactation
-Vaginal dryness is a common presenting problem and can also be caused by local irritants and douching
Psychological - depression, eating disorders, relationship probs

10

General causes of sexual disorders

Chronic medical conditions (CVD/T2DM/Obesity)
Hormonal
Iatrogenic
Psychiatric

11

General investigations for sexual disorders

Full sexual history
Exam
Blood tests: Fasting glucose/lipid ratio, testosterone, SHBG,p prolactin, TSH, oestrogen, FBC, GnRH

12

General psychological treatments for sexual disorders

Integrative - combination of psychosexual options and physical treatments
CBT - sensate focus or self growth programme
Psychodynamic - past events, attachments, partner choice
Systemic - interactions and roles in a relationship

13

Treatment for FSAD

Behavioural: sensate focus, eros therapy device, lubricants
Psychosexual couples therapy

14

Define rapid ejaculation

Inability to control ejaculation sufficiently for BOTH partners to enjoy sexual interaction
Ejaculation occurring within 1 minute

15

Aetiology of rapid ejaculation

Genetic susceptibility
Hyperthyroidism
Penile hypersensitivity
Psychological (performance anxiety, lack of experience, issues, early experience)

16

Treatment of rapid ejaculation

1st line - SSRIs : dapoxetine (increased risk of suicide), STUD 100 spray (topical anaesthetic)
Psychosexual therapy
Behavioural (stop start technique, Kegel exercises)

17

What is female orgasmic disorder

Orgasm does either not occur or is markedly delayed

18

Causes of female orgasmic disorder

Chronic disease (DM, CVD, anaemia, obesity)
Hormonal (androgen deficiency, hyperprolactinaemia, hypothyroid)
Pelvic floor weakness, damage
Ageing
SSRIs
Psychological (abuse, relationship problems)

19

Treatment of female orgasmic disorder

Topical oestrogens
Behavioural interventions - guided masturbation, vibrators

20

What is vaginismus?

Spasm of the pelvic floor muscles that surround vaginal opening.
Make penile entry painful or impossible

21

Causes of vaginismus

Thrush, FGM, congenital abnormality
Psychological: previous trauma/abuse, fear/dislike partner or pregnancy

22

Treatment of vaginismus

Psychosexual
Behavioural: self-exploration, vaginal dilators, graded penetration therapy

23

Define dyspareunia.

Pain during intercourse. Often due to local pathology
ONLY used if no primary non-organic sexual dysfunction.

24

Causes of dyspareunia

Female:
Superficial: STIs, episiotomies, vaginal atrophy
Deep: PID, endometriosis

Male:
STIs, urethral stricturesm, varicocoeles
Psychological
Relationship causes (poor technique of partner)

25

Treatment of dyspareunia

Lubricants
Couples therapy
Behavioural therapy
Poss refer to gynae

26

Presentation of candida albicans (thrush)

Cottage cheese discharge - thick, creamy, odourless
Itching
Soreness
Redness
Dyspareunia
Dysuria

27

Risk factors for candida albicans (thrush)

Pregnancy, DM, Abx, chemo, HIV, vaginal dryness

28

Investigations for candida albicans (thrush)

Clinical diagnosis, MC+S - show Mycelia spores

29

What is candidiasis?

Common yeast infection, NOT STI
Caused by candida albicans - frequently present in normal vagina but kept under control by other bacteria, so only symptomatic when immunosuppressed.

30

Treatment for candidiasis

General advice:
Vulval moisturiser as soap substitute
Avoid tight fitting synthetic clothing
Avoid local irritants like perfumed products

Pharm:
Antifungals - Topical clotrimazole cream stat, clotrimazole pessary if more severe, oral fluconazole (avoid in preg and breastfeeding)

No rx needed for male partner