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43 Cards in this Set
- Front
- Back
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How can a sexual history help establish diagnosis? (3)
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1. Coital injuries
2. STD's 3. Medications that may effect sexuality 4. Sexual problems are common (10-35%) |
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What makes sexual behavior normal?
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Safe and pleasurable for both partners
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Sex occurs despite what adverse consequences (3)
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1. AIDS
2. Syphillis 3. Pregnancy |
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Important aspects of taking a sexual history
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1. have adequate knowledge
2. honesty and trust 3. patient must perceive benefit from sharing 4. base on reliable studies 5. do not share your own info |
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Delayed intercourse is associated with:
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higher rate of marriage
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What are some reasons why teens engage in oral sex but practice vaginal abstinence?
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1. think it will prevent STD's
2. against their morals 3. think they are in the wrong relationship |
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Onset of sexual activity corresponds with:
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surge in testosterone in both males and females at puberty
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What factors led to the sexual revolution?
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1. Oral contraceptives
2. no resistant STD's yet 3. birth control pills |
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Fantasies (4)
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1. are normal
2. absence can indicate depression or sexual disorder 3. most common are with another person, forced sex, observing, and same sex |
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Masturbation
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1. is normal
2. helps individual understand their own sexual response |
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Homosexuals have higher rates of: (3)
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1. anal sex
2. substance abuse 3. promiscuity |
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What causes increased libido? (2)
What decreases it? (6) |
Increase
1. Rise in testosterone 2. between ovulation and menses Decrease 1. pregnancy 2. post partum 3. high prolaction 4. low estrogen 5. menopause 6. low testosterone |
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Sexual problems associated with advanced age: (2)
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1. arousal time prolonged
2. impotence 3. fibrosis |
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How does Depression affect libido? Antidepressants?
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Depression lowers libido
Anti-depressants increases serotonin and also lowers libido, delay orgasm, increase prolaction (further reducing libido) Treating depression increases sexual activity despite antidepressant side effects by improving socialization |
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Components of sexual response (3)
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1. relationship (love is most important for satisfaction)
2. vascular system 3. nervous system |
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What are the components involved in the nervous system during the sexual response? (5)
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1. CNS (brain, brain stem, spinal cord)
2. hypothalamus and olfactory cortex 3. sympathetic nerves - orgasm 4. parasympathetic nerves - arousal 5. vagal nerve - uterine orgasm |
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What are some neurotransmitters and their effects on sexual activity? (8)
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1. serotonin decreases it
2. NE increases it 3. dopamine increase it 4. MSH increase it 5. NO & VIP mediate erection 6. testosterone is necessary in both males and females 7. estrogen necessary in females for testosterone to work 8. oxytocin and ADH mediate attachment |
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What are the phases of the sexual response (4)
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1. arousal
2. plateau 3. orgasm 4. resolution |
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Characteristics: Arousal stage
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- variable duration
- increased blood flow, pressure, respiration, muscle tension, lubrication, erection, areolar size - upper vagina balloons out, lower vagina tightens, uterus lifts out of the way |
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Characteristics: Plateau stage
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- 30-180 seconds
- sex flush - clitoris retracts - vaginal contraction begins - mucoid secretion - pain sensitivity changes |
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Characteristics: Orgasm stage
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- 3-15 seconds
- vagina, uterine, sphincter contractions by sympathetic nervous system (0.8 s intervals) - full sex flush - high BP and respiratory rate - emission and 3-10 seconds of expulsion (male) - spontaneous contractions of torso, legs - euphoria |
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Characteristics: Resolution stage
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- blood drains out
- sex flush disappears - refractory period (male) - up to 24 hours if no orgasm - sweating palms and soles` |
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What are some medical conditions associated with sexual dysfunction
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1. Cancer (breast, prostate)
2. Surgery (sever pelvic nerves) 3. Psychiatric 4. Pulmonary problems 5. Infections (inflammation, STD's) 6. Neurologic (lesions) 7. Cardiovascular 8. Renal/Urologic 9. Gynecologic 10. Orthopedic 11. Endocrine 12. Intersex disorders 13. Gastrointestinal |
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What characterizes a substance-induced sexual disorder?
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Occurs within one month of starting a prescription drug
But BEST predictor of future sexual function is baseline sexual function |
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What is the effect of Oral contraceptives on 1) libido 2) sexual activity
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1. lowers libido (increase binding globulin, less free testosterone)
2. increase sexual activity (freedom from unwanted pregnancy) |
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How did Helen Singer Kaplan contribute to the theory of sexual response? (2)
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1. Added the desire phase (appetite, libido)
2. Consolidated the excitement and plateau stages into the arousal phase |
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Disorders of desire? (2)
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1. Hypoactive sexual desire (lack fantasies, content)
2. Sexual Aversion Disorder (strong negative feelings, panic attack, not pleasurable) |
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Disorders of Arousal (2)
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1. Male Erectile Disorder (impotency or ED, physical and psychological)
2. Female sexual arousal disorder (no lubrication, clitorial engorgement) |
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Disorders of Orgasm (3)
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1. Female Orgasmic Disorder (w/ manipulation but not intercourse, maybe psychological)
2. Male Orgasmic Disorder (absence/delay ejaculation) 3. Premature ejaculation |
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Disorders of Resolution (2)
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Rare
1. postcoital dysphoria/migraine (feeling bad/headache) 2. failure of detumescence (pelvic congestion, priapism) |
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Disorders of Sexual Pain
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1. Dyspareunia - pain during intercourse, females, inflammation
2. Vaginismus - involuntary contraction of outer vaginal, physical and psychological |
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What type of drugs lead to substance-induced Sexual Disorders ?
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Stimulants i.e. Amphetamines (usually after 1 month)
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What are Paraphilias?
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Weird-ass sexual preferences
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Tips for treating sexual disorders (6)
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1. careful history
2. separate generalized from situational disorders 3. treat underlying medical illness 4. treat underlying psychiatric illn ess 5. treatment: sex ed, therapy, focus exercises 6. Sex therapy (homework) |
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Treatment: Desire disorders (7)
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Hypoactive sexual desire
1. Focused history (fantasies) 2. Psychotherapy 3. Couples therapy Sexual aversion disorder 4. focused history 5. psychotherapy 6. benzodiazepines (prevent panic) 7. find underlying issues (overweight) |
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Treatment: Arousal disorders
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Male erectile disorder
1. focused history/exam 2. cognitive behavior therapy 3. sildenafil 4. penile implants, suction pumps 5. hormones, NO enhancer, urethra gel tabs Female 1. focused history/exam 2. estrogen 3. lubrication 4. clitoral suction pump 5. psychotherapy 6. focus exercises 7. NO enhancer |
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Treatment: Orgasm disorders
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Female
1. Educate/encourage learning 2. psychotherapy Male 1. Psychotherapy 2. not wanting children issues Premature ejaculation Relaxation therapy, stop/start technique, squeeze technique, sertoninergic antidepressants |
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Treatment: Sexual pain disorders
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Dyspareunia
1. psychotherapy 2. peyronie's disease - inject plaques, surgery Vaginismus 1. focus exercises 2. relaxation/vaginal dilation 3. correct rigid hymen |
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Treatment: gender dysphoria
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1. Long term psychotherapy
2. hormone therapy 3. sex reassignment surgery |
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Treatment: Paraphilias
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1. psychotherapy
2. behavioral therapy 3. 12 step group 4. serotonergic antidepressants - suppress 5. castration 6. hormone reduction |
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Other sexual disorders
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1. sexual identity
2. body image problems 3. addiction and compulsivity 4. genital mutilation 5. sleep related |
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Specific techniques for taking sexual history
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1. matter-of-fact tone of voice
2. humor 3. substitute correct terms for euphemisms 4. start w/ close-ended, move to open-ended 5. direct questions 6. establish that problems are common and patient will benefit |
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Extended sexual history
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1. past/present relationships
2. casual vs. intimate/romantic/committed 3. sexual development 4. romantic milestones 5. sexual milestones 6. physical milestones 7. gender identity/role 8. forced sex 9. reproduction 10. fantasies 11. talking about sex 12. fears 13. risky behavior |
