Sexual Health – History and Conditions
History
“Are you currently sexually active?” or “Have you ever been sexually active?”
Partners? Practices? Pregnancy prevention? Protection? Past STIs?
Problems/pleasure?
Don’t forget to signpost – and give rationale for asking personal questions
Check biases – do not make assumptions
Clear, understandable language
Symptom Presentations
Erectile Dysfunction
Definition Persistent inability to attain or maintain an erection
Epidemiology
Aetiology - Organic: vasculogenic, neurogenic, hormonal, medications
- Psychogenic: situational or generalised
Risk Factors
Symptoms
Investigations - Physical examination
- HbA1c OR fasting blood glucose
- Lipid profile
- Morning total testosterone
*Low/borderline > measure free T
*Low/borderline > repeat free T + FSH + LH + prolactin
*Further testing abnormal > refer to endocrinology
Management - Manage reversible risk factors – drugs, diabetes, HTN
- PDE-5 inhibitor (sildenafil) regardless of cause – unless
contraindicated (nitrates)
Referrals:
- Urology – young patients with ED or if abnormalities found in
penis/testicles
- Endocrinology – abnormal blood results
- Cardiology – disease contraindicates PDE-5i OR if uncontrolled and
affecting erectile function
- Mental health – psychogenic ED
Questions *Organic – onset? normal libido? risk factors?
*Psychogenic – sudden onset? decreased libido? normal self-stimulated
erections? stressors/problems within relationship?
Premature Ejaculation
, Definition Ejaculation that occurs sooner than desired
= distress to one or both partners
Epidemiology
Aetiology Consider:
- Prostatitis
- Thyroid disease
- Psychological distress
Risk Factors
Symptoms
Investigations
Management - Psychosexual counselling
- Topical anaesthetics
- Dapoxetine (short-acting SSRI) – 1/3 hours before sex
Decreased Libido
Definition Low sex drive causing distress
Epidemiology
Aetiology - Low testosterone
- Hypothyroidism
- Anxiety/depression
- SSRIs/SNRIs
- Recreational drugs
Risk Factors
Symptoms
Investigations
Management - HRT or testosterone for post-menopausal women
- Relationship counselling
- Managing problems arising during intercourse (dryness/ED)
Anorgasmia
Definition Persistent/recurrently delayed, infrequent or absent orgasms
Epidemiology
Aetiology - Neurological disorders
- Gynae surgeries
- Medications (SSRIs/diuretics)
- Alcohol/smoking
- Psychological problems
Risk Factors
History
“Are you currently sexually active?” or “Have you ever been sexually active?”
Partners? Practices? Pregnancy prevention? Protection? Past STIs?
Problems/pleasure?
Don’t forget to signpost – and give rationale for asking personal questions
Check biases – do not make assumptions
Clear, understandable language
Symptom Presentations
Erectile Dysfunction
Definition Persistent inability to attain or maintain an erection
Epidemiology
Aetiology - Organic: vasculogenic, neurogenic, hormonal, medications
- Psychogenic: situational or generalised
Risk Factors
Symptoms
Investigations - Physical examination
- HbA1c OR fasting blood glucose
- Lipid profile
- Morning total testosterone
*Low/borderline > measure free T
*Low/borderline > repeat free T + FSH + LH + prolactin
*Further testing abnormal > refer to endocrinology
Management - Manage reversible risk factors – drugs, diabetes, HTN
- PDE-5 inhibitor (sildenafil) regardless of cause – unless
contraindicated (nitrates)
Referrals:
- Urology – young patients with ED or if abnormalities found in
penis/testicles
- Endocrinology – abnormal blood results
- Cardiology – disease contraindicates PDE-5i OR if uncontrolled and
affecting erectile function
- Mental health – psychogenic ED
Questions *Organic – onset? normal libido? risk factors?
*Psychogenic – sudden onset? decreased libido? normal self-stimulated
erections? stressors/problems within relationship?
Premature Ejaculation
, Definition Ejaculation that occurs sooner than desired
= distress to one or both partners
Epidemiology
Aetiology Consider:
- Prostatitis
- Thyroid disease
- Psychological distress
Risk Factors
Symptoms
Investigations
Management - Psychosexual counselling
- Topical anaesthetics
- Dapoxetine (short-acting SSRI) – 1/3 hours before sex
Decreased Libido
Definition Low sex drive causing distress
Epidemiology
Aetiology - Low testosterone
- Hypothyroidism
- Anxiety/depression
- SSRIs/SNRIs
- Recreational drugs
Risk Factors
Symptoms
Investigations
Management - HRT or testosterone for post-menopausal women
- Relationship counselling
- Managing problems arising during intercourse (dryness/ED)
Anorgasmia
Definition Persistent/recurrently delayed, infrequent or absent orgasms
Epidemiology
Aetiology - Neurological disorders
- Gynae surgeries
- Medications (SSRIs/diuretics)
- Alcohol/smoking
- Psychological problems
Risk Factors
