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Sexual Dysfunction & Sexual Assault - Coggle Diagram

- - - - Younger men with no identifiable medical risk factors
      - Continuing early morning erections
      - Erections maintained during masturbation
      - Erections adequate for intercourse with a different partner
      - Man can recall onset
    - - Gradual onset
      - Constant dysfunction with partial / poorly sustained erections
      - Medications likley to have effect
        
        Antipsychotics
        
        Antidepressants
        
        Antihypertensives
      - Phx
        
        Chronic illness
        
        CVS - ED is a strong indicatory
    - - Within 1 min of vaginal penetration
      - 20% of men
      - No underlying cause - anxietu plays a role
- - - - Primary Anorgasmia
        
        Never experienced orgasm / have no felt sexual excitement
        
        Causes
        
        Lack of ability of partner
        
        Deep routed suppression of sexual feelings
      - Secondary Anoegasmia
        
        Pt previously experienced orgasm but has stopped
        
        Causes
        
        Psychosexual (most common)
        
        Physical
    - - Overlapping diagnosis of Vaginismus + Dyspareunia
      - Vaginismus
        
        Involuntary tightening of vaginal muscles during penetration
        Automatic reaction to fear of vaginal penetraion
        
        Presentation
        
        Pain on inserting tampons
        
        Pain at sexual penetration
      - Dyspareunia
        
        Superficial dyspareunia
        
        Pain felt in the labia, introitus and lower part of vaginal during sexual intercourse
        
        Presentation
        
        Typically starts at initial penetration
        
        Precipitating causes
        
        Childbirth trauma with scaring
        
        Breastfeeding - low OE levels
        
        Recurrent thrush
        
        Vulval dermatitis
        
        Deep Dyspareunia
        
        Pain occuing during or after deep intercourse
        
        Causes
        
        Interstitial cystitis
        
        PID
        
        Endometriosis
        
        Adhesions
        
        Fibroids
    - - Presentation
        
        Diminished sexual interest, desire, sexual thoughts, fantasies and reponsive desire
        
        Absent / reduced genital and non genital sensations during sex
      - DDx
        
        Desire discrepancy between partners
- - - - Partner factors
        
        Health status
        
        Blame
        
        Partner's sexual problems
      - Relationship factors
        
        Poor communication
        
        Desire discrepancies
      - Individual vulnerability factors
        
        Poor body image
        
        Hx abus
        
        Previous experiences
      - Psychiatric comorbidity
        
        Depression
        
        Anxiety
      - Stressors
        
        Job loss
      - Socio / Culture / Religious factors
    - - Endocrine
        
        Hypothyroid
        
        Hyperprolactinaemia
        
        Diabetes
        
        Oestrogen / testosterone deficiency
        
        Postmenopausal
        
        TAH / BSO
      - Neurological
        
        MS
      - Vascular
        
        CVD
      - Pscyhiatric
        
        Psychosis
        
        Depression
        
        Anxiety
      - Chronic Illness
        
        HIV
        
        Chronic renal failure
    - - Anticonvulsants
      - Opiates
      - Lithium
      - Antipsychotics
      - Benzodiazepines
      - Antidepressants
      - COCP
      - B Blockers
      - Steroids
      - Rx for oestrogen sensitive breast cancer
      - Post chemo / pelvic floor radiotherapy
  - - - Awareness of inter-related / multifaceted nature
      - Biopsychosocial approach
    - - Psychosexual therapies
      - Relaxation techniques
      - Pelvic floor exercises
      - Vaginal trainers
- - - - Any sexual act that is not sonsented to, or is forced against a persons's will: groping, rape, forces to kiss
        Includes rape
        Is a crime no mattre who / where
    - - A person does not consent and someone puts their penis into (penetrates) the person's vagina, anus, or mouth, or puts any object into a person's vagina
  - - - Rotunda hospital
      - Child & Adolescent Forensic Medical Services OLCH Crumlin
    - - Healthcare professions has to report to TUSLA and Gardai
  - - - Samples can be taken up to 7 days after assault
      - Options
        
        Report assualt - give evidence to Gardai
        
        Evidence stored up to 1 yr - Gardai not present
      - Components
        
        Documentation of injuries
        
        Combings from hair
        
        Swabs from nails
        
        Bloods
        
        Urine samples
        
        Vaginal / penile / rectal swabs
        
        Clothes taken by Gardai for analyssi
    - - Do no eat, drink, brush teeth, use mouthwash, smoke, vape, shower, bath, go to toilet, wash clothes or underwear, touch or throw away condoms used
    - - Exam, treat, document injuries
      - STI prophylaxis
      - Arrange STI testing / follow-up
      - Any referrals needed
    - - Emergency contraception
      - Antibiotics to prevent STIs
      - Hep B vaccine
      - HIV (PEP) - within 72 hr of possible exposure to HIV