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75 Cards in this Set
- Front
- Back
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What has happened to the % of sexual dysfunction that is purely due to psychological factors? Why?
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It is decreasing - dt growing numbers of meds, surgeries, and other treatments that cause it as a side effect.
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What is usually the cause of an inability to gain erection with sexual stimulation?
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A functional disorder - Psychogenic
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What are the top 2 diseases which have the greatest effect on sexual function?
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1. Diseases of the GU tract
2. Diseases of the repro system |
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What are the next 3 diseases that affect sexual function?
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CV disease
Resp disease Endocrine disease |
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What is surprising to physicians treating patients whose lives are threatened by illness?
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These patients are still FREQUENTLY concerned about sexual functioning.
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How does sexual deprivation from hospitalization affect patients?
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-Increases feelings of loneliness and isolation
-Causes loss of self-esteem -Impedes recovery from most illnesses |
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What was thought to be the balance of etiology of most sexual dysfunction in 1976?
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Psychogenic (functional) - 90%
Organic - 10% |
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What is thought to be balance of etiology of most sexual dysfunction today?
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Organic is 40%
Psychogenic is 40% Mixed is the rest |
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What are 5 reasons docs give for not meeting the need of sexual history taking?
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-Doubts if patient warrants it
-Discomfort with subject -Lack of time -Belief this area is for specialists, research is needed |
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What are 5 components of any illness that will produce sexual dysfunction?
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-Fear of death
-Acute or chronic pain -Weakness -Nausea -Deformity |
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What are 5 specific medical causes of sexual dysfunction?
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-Spinal cord injury
-Multiple sclerosis -Diabetes -Major depression -Pain syndromes |
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What determines whether diabetes will cause sexual dysfunction?
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The duration of the illness in the individual
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What are pain syndromes associated with sex dysfunction?
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-Prostatitis
-Cystitis -Endometriosis -PID |
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In what disease is fear of death predominantly a block to sex?
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Cardiac disease
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Why do pituitary tumors reduce sexual dysfunction?
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Bc of increased prolactin
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What is the demand of CO and O2 cost during sex normally equiv to?
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Walking briskly or climbing up a flight of stairs
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When does sex usually precipitate death in a patient with cardiac disease?
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When it's extramarital, or under unusual/novel circumstances.
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What position in sex will create the least effort for the male in patients with CAD?
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Female on top
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How does Prostatic disease and cystitis decrease sexual functioning?
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By precipitating fear of sexual inadequecy and dysfunction.
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What resp diseases are frequently associated with some sex dysfunction?
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-COPD
-Bronchial asthma |
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Why do these Resp diseases cause sexual dysfunction?
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Because the male becomes dependent on the female for care causing a psychological conflict and relationship disturbance.
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What does Diabetes do to 25% of males under 40?
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Causes impotence
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Is diabetes-induced impotence related to meds or whether the patient is controlled or stable?
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no
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What do 50% of females with diabetes have after 20 yrs of having it?
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Anorgasmia
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What is the physician's role whe patients with diabetes experience failure or dysfunction?
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Reinforcement of the change in sexual function by stating that its a normal occurence in diabetes.
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How does chronic renal disease cause sexual dysfunction?
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Anemia and Uremia result in loss of desire.
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What happens to their sexual desire with treatment for chronic renal disease?
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It gets worse, not better.
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Does dialysis help the loss of desire?
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No
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What does improve sexual functioning in some females with chronic renal disease?
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Transplant
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How can a physician maximize helping a patient return to sexual health?
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-By being willing to discuss sexuality
-By reassuring the patient and treating the couple together |
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What are 3 things you need to look at in evaluating sexual dysfunction?
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-Loss of desire
-Loss of ability -Loss of both |
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What are 5 requirements for good DESIRE?
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-Good health
-Good partner -Erotic stimuli -No drugs -Testosterone |
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What 4 things will block desire then?
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-Depression
-Dysfunctional partner -SSRIs/Antidepressents -Low testosterone |
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What are the 5 major medical disease causes of loss of ability for sex?
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-Spinal cord/pelvic injury
-Diabetic neuropathy -Vascular disease -CNS illness - MS -Surgery |
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What are 3 main causes of loss of BOTH desire and ability for sex?
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-Significant psychologic issues like absolutely no libido
-Some prescription meds -Complicated medical situations |
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What do SSRI's affect - desire or ability?
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Desire
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What do older antidepressants's affect - desire or ability?
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Ability
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What do Antipsychotics affect - desire or ability?
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BOTH
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What do Anticholinergics affect - desire or ability?
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Ability
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What do Steroids and other hormones like Prolactin affect - desire or ability?
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Desire
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What do the older antihypertensive drugs affect, desire or ability?
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Both
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What 3 NONprescription drugs are associated with sex dysfunction?
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-Alcohol
-Marijuana -OTC sedatives |
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How does Alcohol affect sexual function?
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-Increases desire
-Decreases ability |
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What is Peyronie's disease?
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Plaques on the penis which cause pain with erection
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How is Peyronie's treated?
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With surgical removal
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What is the most common cause of organic sex dysfunction in young people?
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Spinal cord injury
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What determines the loss of sensation in sc injury?
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The level of the injury
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What is left intact for women in sc injury?
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-Ability to be become pregnant and deliver
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What is left intact for men in sc injury?
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-Reflexogenic erections
-Psychogenic erections |
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At what level of the spinal cord will natural erection be very difficult?
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Below S2/S3
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What are the top 2 organic causes of erectile dysfunction in males?
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-Vascular disease
-Diabetes |
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What % of males age 70-80 have ED?
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80%
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What is a way to diagnostically measure if a man has ED aside from them telling you?
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Sleep lab - look for nocturnal penile tumescence
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When during sleep should you have nocturnal penile tumescence?
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During REM
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What are 3 mechanical devices for treating ED?
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-Mechanical vacuum devices
-Rigid implants -Inflatable implants |
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What are 4 medications for treating ED?
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-Alpha2 adrenergic antagonists
-Synthetic PGE1 -PDE-5 inhibitors -Central dopamine agonists |
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What is Yohimbine? What does it do?
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An a2 antagonist - increases bloodflow
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What drug is used as a PGE1 agonist for ED?
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Alprostadil
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What does Alprostadil do?
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Relaxes smooth muscle and increases intracellular cAMP
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What are 2 forms of administration for Alprostadil?
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-Injection
-Pill that is inserted into urethra |
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What are the 3 Phosphodiesterase -5 inhibitors?
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-Sildenafil
-Vardenafil -Tadalafil |
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Which PDEi has the longest half life?
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Tadalafil
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Does Viagra actually cause erection?
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No, it prevents it from breaking down, so makes it last longer once the patient starts it themselves.
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Does Viagra treat much sexual dysfunction in women? Why?
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No - bc most have hypoactive sexual desire disorder and viagra doesn't treat that.
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What would Viagra do for women? What patients?
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Increase vascular engorgement and lubrication - in Diabetes or on SSRIs
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What is the cheapest treatment for ED?
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PDE5 inhibitors
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What is the next cheapest treatment for ED?
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MUSE - the pill of Alprostadil
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What treatment for ED costs the most?
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The surgical implants
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Is MUSE only available for men?
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No there is Alprostadil cream for women who find self-stimulation unacceptable :)
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What does the alprostadil do for women?
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Increases genital bloodflow.
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What 2 things does Bremelanotide achieve at the same time?
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-Makes you tan
-And gives you sexual arousal |
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How does Bremelanotide work?
How is it administered? |
By activating melanocortin receptors in the hypothalamus.
By nasal spray |
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What is the rationale for testosterone therapy?
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-Increases sexual DESIRE and activity in menopausal women
-Improves sexual FUNCTION in post menopausal women |
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What is the main cause of low testosterone in women?
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Normal aging
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What is the most dramatic 2ndary cause of reduced testosterone production?
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Oophorectomy - taking out the ovaries
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