Sexual Problems

Question 1

In a psychosexual consultation what does

LOFTI stand for?

Answer 1

Listen - open qs, silence, tone, style, words
Observe - body language, behaviour, canellations, dress
Feelings - how does the patient make you feel
Thinking - doctor style in consultation (parent, teacher), why patient presented now
Interpret - overall picture, pt attitudes, defence mechanisms

Question 2

Examples of defence mechanisms for psychosexual patients

Answer 2

Regression
Dissociation 
Introjection
Sublimation
Denial
Avoidance

Question 3

Characteristic psychological pattern of women with chronic pelvic pain without a physical cause

Answer 3

Difficult childhood
Poor parental affection
Lack of parental interest
Previous unsuccessful relationships
Dysparunia
Loss of libido 
Anxiety disorders / neuroticism

Question 4

What is vaginismus

Answer 4

involuntary spasm of the pubococcygeal muscle and associated muscles

painful and difficult vaginal penetration

can be primary or secondary

Question 5

what is vulvodynia

Answer 5

vulval discomfort / burning or pain in the absence of any visible findings
No specific identifiable cause or neurological disorder

Provoked or unprovoked
Classified according to genital site

Question 6

What conditions are often associated with vulvodynia

Answer 6

psychological conditions

• anxiety
• depression
• somatisation
• hyperchondriasis

Question 7

Management of vulvodynia

Answer 7

pelvic floor exercises
external / internal soft tissue self massage with organic lubricants
triger point pressure
biofeedback
vaginal trainers
acupuncture
lidocaine cream
capsicum cream
amitryptilline / gabapentin / pregabalin

Question 8

what is hypoactive sexual desire disorder

Answer 8

loss of libido
decline in sexual desire
causing distress and interpersonal difficulties

Question 9

Causes of hypoactive sexual desire disorder

Answer 9

Psychosexual causes
depression
menopause
TCAs
SSRIs
chemotherapy
radiotherapy
ooporectomy

Question 10

What is tokophobia

Answer 10

fear of pregnancy and childbirth
more common in primigravid women
anecdotally is increasing

Question 11

Causes of primary tokophobia

Answer 11

primary tokophobia = in nullips / primips

• adolescence - reinforced to avoid pregnancy at all costs
• cultural attitudes
• family attitudes
• media
• childhood abuse
• adult abuse

Question 12

Causes of secondary tokophobia

Answer 12

secondary tokophobia - after previous birth

• previous traumatic birth
• previous instrumental delivery
• spontaneous birth
• previous termination
• previous stillbirth / neonatal death

Question 13

What factors should be explored in women with tokophobia?

Answer 13

triggering factors
causes of concern
- fear of pain
- fear loss of control
- fear of harm to self
- fear of harm to baby
- lack of support
- concern about vaginal stretching
- concern their anatomy is not normal

Question 14

Causes of erectile dysfunction

Answer 14

Can be caused by physical or psychological problems.

Physical causes

• diabetes
• high blood pressure
• heart disease
• hormonal problems
• alcoholism
• serious illnesses such as cancer.

Psychological problems including

• stress,
• depression,
• previous negative experiences
• anxiety
• underlying relationship issues

Question 15

Lifestyle changes to improve erectile dysfunction

Answer 15

Smoking cessation 
Healthy diet
Reduce weight
Exercise 
Reduce stress 
Reduce alcohol

Question 16

How common is Peyronie’s disease?

Answer 16

6 - 10%

Question 17

what is Peyronie’s disease?

Answer 17

Develops as a hard lump in the erectile tissue of the penis.
This inelastic scar tissue stops the penis stretching
with erections on that side leading to a curvature on erection

Question 18

prevalence of POI

Answer 18

prevalence of POI - approximately 1%.

Question 19

Prevalence of female Hypoactive Sexual Desire Disorder

Answer 19

Estimated
7.4% to 12.3% of women
Highest prevalence aged >45-64yr

Question 20

Aetiology of female hypoactive sexual desire

Answer 20

Often multifactorial,

• hormone status
• medical conditions
• medications
• psychological - depression/ anxiety/ stress
• substance abuse
• history of sexual abuse / trauma
• interpersonal factors - relationship quality, partner sexual function
• cultural factors - sexual norms / religious values

Question 21

Suggestion to initiate the general discussion and assessment of sexual health concerns and sexual dysfunction

Answer 21

Explain sexual health is an important aspect of overall health
Explain that assessment of sexual function is a routine part of good medical care.

Ask a brief questions e.g. “Many patients have sexual concerns at midlife—what concerns do you have?” or “How do you feel about your current level of desire and your ability to get aroused or to orgasm?” T
Consider using - Decreased Sexual Desire Screener = five questions - available online

Offer patient-friendly leaflets
Consider including questions about sexual health topics on intake forms / triage forms

Question 22

Management of female hypoactive sexual desire disorder

Answer 22

Psychotherapy
Flibanserin (licensed in USA but not UK) - nonhormonal, 100mg PO ON
Testosterone