Sexuality Ch 28.ppt

1、2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,SexualityCh 28,2009-2010 Academic Year MSIII Ob/Gyn Clerkship Self-Directed Study,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Case Study,42 yo G4P4 presents to gyn clinic with c/o decreased libido. She states that she is h

2、appily married for 14 years. After further discussion, she confides that she rarely has orgasm and worries that her husband will leave her if she does not have more interest in their sex life.,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,APGO Educational Topic 56:,A. Obtain a basic s

3、exual history, including sexual function and sexual orientation. B. Describe the physiology of female sexual response. C. Discuss female sexuality across the lifespan. D. Categorize common patterns of female sexual dysfunction. E. Identify physical, psychological and societal contributions to female

4、 sexual dysfunction.,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Basic History (Page 356),Are you sexually active? Are there any problems with your sexual function? (Can preface with “Many people experience sexual dysfunction”) What is our sexual orientation? What age did you first

5、have intercourse? How many partners have you had? Do you use birth control? How do you protect yourself from STDs (if multiple partners)?,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Sexual Orientation,Heterosexual Engage in sexual activity with opposite sex Homosexual Engage in sexu

6、al activity with same sex Bisexual Engage in sexual activity with both sexes at same or different times of their life,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Sexual Response Cycle,Excitement Phase Stimulation Plateau Phase Continuation of physiologic changes Orgasmic Phase Relea

7、se of sexual tension Resolution Phase Return to baseline physiologic state,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Excitement Phase,Chest sex flush Nipples become erect Breasts enlarge Uterus elevates Vaginal lubrication starts Clitoris enlarges Labia enlarges HR increases BP in

8、creases Muscles become tense,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Plateau Phase,Uterus tents (allows easier sperm passage Vagina enlarges Clitoris elevates, retracts under hood Labia enlarges HR increases BP increases RR increases Muscles become tense Bartholins glands lubric

9、ate introitus,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Orgasmic Phase,*Clitoris, Vagina, and Uterus Vaginal muscles contract Uterus contracts Lower abdominal muscles contract Anal muscles contract HR peaks BP peaks RR peaks Muscles loss of voluntary tone (Toes curl),*Women can ha

10、ve Multiple orgasms Before next phase!,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Resoluton Phase,Chest sex flush disappears Nipples decrease in size Breasts decrease in size Uterus returns to normal size Vagina returns to normal size Clitoris returns to normal size HR normalizes B

11、P normalizes RR normalizes,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Lifespan - Sexuality,Increasing age associated with decreased frequency and satisfaction of intercourse. Decreased estrogen Vaginal atrophy and dryness Dypareunia Difficulty in achieving orgasm,2009-2010,USUHS MS

12、III Ob/Gyn Clerkship Self Directed Studies,Female Sexual Dysfunction,Sexual dysfunction Failure of 1 or more of the phases of the sexual response cycle (desire, aousal, orgasm) or pain disorders. Primary Realistic expectations have never been met. Secondary All phases have functioned in past, but 1

13、or more no longer functions. Situational Response cycle functions in some situations, but not other situations.,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Sexual Response Cycle Disorders,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Pain Disorders,Vaginismus severe p

14、ain +/- involuntary muscle spasm of distal vaginal and pelvic floor muscles during attempted penetration.,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Physical, Psychological and Societal contributions to female sexual dysfunction,Society Expectations What is socially or culturally acceptable,Physical Secondary sexual function d/os External disease (cancer, hysterectomy) Medications (SSRIs) Genital infections Diabetes,Psychological Primary sexual function d/os Depression Anxiety,2009-2010,USUHS MSIII Ob/Gyn Clerkship Self Directed Studies,Treatment,Hormonal