Sexual Function and Dysfunction

Question 1

What are the two broad categories of Sexual problems

Answer 1

1. Impairments to physiology ie: sexual dysfunction
2. Impairments in the human relations part of the sexual experiance ie: diffiulties/consequences of the ways people conduct themselves sexually

Question 2

What types of non-physiological sexual dysfunction is there?

Answer 2

Psychological:

• interpsychic- relationships, communication
• Intrapsychic- beliefs, meanings, conflicts, guilt, shame, information distortion, past sexual trauma, depression/anxiety

Social:

• Situational

Question 3

Whats the PLISSIT model?

Answer 3

Developed as a solution for sexual counselling.

Suggests interventions for some common sexual dysfunctions.

4 levels of complexity:

Permission to talk about sexual matters, fantasize

Limited Information

Specific Suggestions

Intensive Therapy

Question 4

Female Sexual Dysfunction

Answer 4

Sexual interest/aurosal disorder: low desire the most common complaint.

Female orgasmic disorder
Genito-pelvix pain/penetration disorder

• Must be 75-100% of the time
• minimum duration of ~6months
• cause significant stress

Lifelong vs acquired
Severity scale

Question 5

Associated factors of female sexual dysfunction

Answer 5

Question 6

Treatment of FSD

Answer 6

Is there really a problem? Who’s problem is it?

Education

• *Counselling**:
• patient/couple
• sensate focus

Manage medical issues: menopause, hormone replacement therapy, physiotherapy

Question 7

Male Sexual Dysfunction

Answer 7

• Male hypoactive sexual desire disorder
• Delayed ejaculation
• Erectile Disorder
• Premature ejaculation

***same associated factors as women

Question 8

Low libido in men

Answer 8

• Psycholoical: fatigue, situational factors, depression
• Physical: hypothroidism, hypogonadism (low testosterone), PADAM
• Other: medication

Question 9

Biomedical mechanisms in getting an erection

Answer 9

Question 10

Anatomy of a flaccid penis

Answer 10

During erection these arteries (helecine and cavernossus) swell and compress the veins

Question 11

Definition of Erectile Dysfunction

Answer 11

Persistant inability for at least 3 months, to obtain/maintaina n erection sufficient for satisfactory sexual performance

-Increases with age

Organic vs psychogenic

-Chronic illness, surgery, trauma

Question 12

What percentage of men age 40-70yrs experiance ED?

Answer 12

~52%

only around 10% full impotence

Question 13

What is the Cause of Erectile Dysfunction

Answer 13

Organic: vascular, neurological, hormonal issues

Psychogenic: usually secondary

• Can be a combo of both*
• Eg: systemic disease, neurogenic disease, penile dosorder, psychiatric dsorder, endocrine disorder*

Question 14

Chronic Illness: a penile disorder example?

Answer 14

Peyronie’s disease: a fibrous change, a thickening in the tunica (from previous inflamm process) → physical distortion of the erect penis.

1/3 get better, 1/3 get worse, 1/3 stay the same

Question 15

How can prostate surgery be an issue?

Answer 15

Can damage many vessels/nerves → erectile dysfunction

Question 16

What types of surgery can lead to erectile dysfunction?

Answer 16

Spinal cord injury

Pelvic injury/surgery

Prostatectomy

Question 17

Modifiable factors of Erectile Dysfunction

Answer 17

• Alcohol consumption
• Cigarette smoking
• Drugs: anti-hypertensives, anti-depressants, hormones, tranquelizers etc

These can be controlled by the patient!

Question 18

Basic Management of ED

Answer 18

Diagnose the issue
Evaluate co-morbidities: heart disease, vascular disease, depression
What does the couple want?
Adjust meds
Address lifestyle
Education
Tailored treatment

Question 19

Why/how is a lot ofthe psygoneic issues secondary?

Answer 19

Something goes wrong → loss of confidence →lack of interest → performance anxiety → sexual dysfunction/ actual issues during the sexual experiance

Question 20

Treatment for performance anxiety and ED

Answer 20

Mindfulness based approach a component

Question 21

Non-invasive options for Erectile Dysfunction treatment

Answer 21

• eliminate modifiable risk factors
• Counselling and/or psychotherapy
• medication
• vacuum constriction devices

Question 22

Invasive therapy trreatments for ED

Answer 22

• Transurethtral drug application
• Intracavernous injection therapy
• Prosthesis implantation
• Venous/arterial surgery

Question 23

Phosphodiestarase 5 inhibitors (PDE5) used are?

Answer 23

1. Sildenafil: ‘viagra’
2. Tadalafil: ‘Cialis’ longer duration of action, option of low dose (5mg) daily, (maintains oxygenation thus improving endothelial smooth muscle health)
3. Vardenafil: ‘Levitra’, shorter duration of action

Question 24

Other drug/physical approaches to ED treatment?

Answer 24

• Alprostadil injected into c.cavernosa
• Bimix
• Trimix
• ED shock wave theray
• Vacuum device
• Surgery

These can lead onto other issues!

Question 25

What is rapid (premature) ejaculation?

Answer 25

When ejaculation occurs before the individual wants it to! (subjective)

Question 26

What are the traditional theories and responses to rapid/premature ejaculation

Answer 26

Traditional Theories: - furvitive early masterbation - too exciting vagina - Genital hypersensitivity - lack of alarm signal Traditional therapeutic responses - sensate focus with 'squeeze' technique - Stop-start technique - local anathestic spray not that legit

Question 27

Neurobiological approach to erectile dysfuntion

Answer 27

Selective serotonin reuptake inhibitors (SSRIs) which are antidepressants *(increase serotonin levels)* have proven to cause delayed ejaculation. ## Footnote found via experimental evidence of - decreased serotonin neurotransmission - hypo function of 5-HT_2c receptors - Familial aspects By flooding the underfunctioning receptors with serotonin via SSRIs daily

Question 28

Drug treatment for premature ejaculation

Answer 28

* Dapoxetine (priligy^TM) 30mg or 60mg: main drug on the market, quickly metabolised! * SSRI's daily or clomipramine daily or 12 hours before sex

Question 29

Delayed (retarded) ejaculation

Answer 29

Definition unclear. Generalised or situational Lifelong DE relatively uncommon *(1.5 per 1000 or 3-4%)* Attributed to *fear, anxiety, hostility and relationship difficulties* Contemporary theory: *Waldinger's Ejaculation Distribution Theory (EDT), bell curve*

Question 30

Causes of Delayed Ejaculation

Answer 30

1. **Hypofunction of 5-HT_1A receptors** - and/or hyperfunction of 5-HT2c receptors - Treament research into 5-HT_1A receptor agonists 2. **Acquired DE** - Psychological - Some disease states: neurological condition - Meds: SSRIs, tricyclic ADs, antipsychotics