Sildenafil
ViagraPDE-5 inhibitor
Vardenafil
LevitraPDE-5 inhibitor
Tadalafil
CialisPDE-5 inhibitor
Alprostadil
Caverject -injection of prostaglandin E (vasodilator) into corpora cavernosa
Flibanserin
Addyi- increases sexual desire in women
topical SSRI and TCA cream
anesthetic for premature ejaculation
trazadone
Desyrel- improves nocturnal erection
Bromocriptine
Parlodel- improve hyperprolactinemia
parenteral androgens
increase sex drive in men and women (watch for HTN, prostatic enlargement and virilizing effects)
locally delivered estrogens (rings, creams, tablets)
arousal problems and genital atrophy
antiandrogens
for compulsive sexual behavior - sex offenders
clomiphene
antiestrogen
tamoxifen
Antiestrogen
antiestrogen MOA
stimulates GnRH secretion and increases testosterone concentrations increasing libido
Bremelanotide
melanocortin receptor agonist- for hypoactive sexual desire in premenopausal women. C/I in HTN and CVD
S/E of bremelanotide
nausea, flushing, hyperpigmentation, cough, fatigue, vom, injx site rxn
penis vacuum pump
draws blood into penis, C/I vascular dz
Eros device
small clitoral suction cup
male prostheses
semi-rigid rod or inflatable type
post-coital dysphoria
feelings of sadness, anxiety, and/or irritability after sexual intercourse that was otherwise physically satisfactory- MC in men
couple problems
couples preferring different things
unconsummated marriage
from sexual prohibitions as a child/from religion/from parents, lack of sex ed, ect
sex addiction and compulsivity
associated with mood disorders and schizophrenia; high correlation w substance abuse
Don Juanism
hypersexual men that mask feelings of inferiority, some have homosexual fantasies they suppress by having sex with many women- AKA satyriasis or sex addiction
nymphomania
compulsive sexual needs on the part of a female- often w fear of losing love
Medroxyprogesterone
diminishes libido in men
female premature orgasm
reported in women taking fluoxetine and clomipramine - orgasmed while yawning
paraphilia
Having sexual arousal to unusual stimuli- NEED it to be aroused (pedophilia, voyeurism, sadism) - very one sided often harm the other being
MC paraphilias
pedophiles
exhibitionism
compulsive need to expose one's body, particularly the genitals, to an unsuspecting stranger
fetishism
sexual attraction to nongenital body parts or other things closely associated with the human body
frotteurism
Compulsion to achieve sexual arousal by touching or rubbing against a nonconsenting person in public situations
pedophilia
sexual urges towards children under 13 over period of 6 mo
sexual masochism
suffering pain or humiliation to attain sexual gratification
sexual sadism
paraphilia in which sexual arousal is associated with inflicting pain or humiliation
john moneys 5 contributory causes to sadism
hereditary, hormonal malfunction, bad relationships, h/o sexual abuse, other mental disorders
voyeurism
scopophilia" observing victims naked or in sexual acts
transvestism
the practice of deriving sexual gratification from dressing as a member of the other gender
sexual identity
biology
testis grow from
SRY and SOX9
ovaries grow from
absence of SRY and SOX9
gender identity
sense of maleness or femaleness
gender role
what you say and do to affirm gender identity - mostly learned
sexual orientation
who you are attracted to and your sexual impulses
desire disorder
asexual
Cowper's gland (bulbourethral gland)
small gland that produces fluid that neutralizes acid and lubricates urethra so sperm are not damaged as they flow through the urethra
Masters and Johnson
psychologists; studied human sexual behavior, described four stages of sexual response
tumescence
swelling
detumescence
diminishing or lessening of swelling (orgasm)
phase 1 - excitement
increased HR, RR, blood flow to genitalia, lubrication and pre-ejaculant
phase 2- plateau
dark purple vagina, sensitive clitoris that may retract under hood, testis withdrawal, spasm begin
phase 3 - climax or orgasm
intense muscle contractions, ejaculation, "sex flush
phase 4 - resolution
feeling of calmness, men need refractory period
testosterone
increases libido
dopamine
increases desire
estrogen
increases lubrication
progesterone
decreases desire
what is released during orgasm
oxytocin
what rises with orgasm in men
PSA- avoid 7 days before testing levels
heterosexism
thinks straight is superior
homosexuality removed from DMS-5 when
1980
Rollo May
active receiving" is key for good love
Freud believed psychological health needed
work and love
male hypoactive sexual desire dso
decreased fantasies and arousal for over 6 mo
Causes of MHSDD
stress, anxiety, failing relationship, low self esteem. Freud: unresolved phalic conflicts/fears vagina?
female sexual interest/ arousal dso
desire sex but cant get aroused- low lube. MC caused from marital discord
male erectile disorder
organic (biological) vs psychological , lifelong vs. aquired,
Madonna-Putana complex
only aroused with hookups and non meaningful sex
female orgasmic dso
inability to orgasm via masturbation or coitus - psychological and biological reasons
delayed ejaculation
mostly with coitus not masturbation- from antidepressants or increased porn. May feel guilt or be associated with ADHD or OCD.
premature ejaculation
moderate: 15-30 seconds, severe: before 15 seconds of insertion. More common in educated men.
genito-pelvi pain/penetration disorder
painful sex
dyspareunia
Pain before, during, or after coitus. Often associated with vaginismus and h/o rape and postmenopausal women.
vaginismus
Constriction of outer 1/3 of vagina affecting insertion of penis. Associated with trauma, strict religious upbringing, and increased education.
sexual disfunction due to GMC
Functional vs. organic (biological)- can determine with plethysmograph (penis BP) or doppler US. Can have retrograde ejaculation where seminal fluid goes backwards into bladder- from GU surgery.
what can impair excretion and ejaculation
antipsychotics- chlorpromazine and trifluoperazine
what decreases sex drive and delays ejaculation/orgasm?
SSRIs and NSRIs
what can increase sex drive?
clomipramine, selegiline, and buproprion
what can reverse increased sex drive from the above?
cryoheptadine and ritalin
what can cause priapism?
Trazodone
what other antidepressants cause sexual dysfunction?
TCAs
effects of alcohol
decreased erections, testosterone, and increased estrogen causing gynecomastia and testicular atrophy