Summary physiotherapeutic theory: sexual disorders (pelvic rehab)

Physioth. Theory: pelvic reëducation in neuroP: sexual disorders
SEXUALITY

 Biological factors
 Psychological factors
 Relational factors
 Cultural factors


DSM-V CLASSIFICATION – FEMALE AND MALE DYSFUNCTIONS

 ≥6 months present
Female dysfunctions Male dysfunctions
Female sexual interest/arousal disorder Erectile disorder
Female orgasmic disorder Male hypoactive sexual desire disorder
Genito-pelvic pain/penetration disorder Premature (early) ejaculation
Delayed ejaculation

1. GENITO-PELVIC PAIN/PENETRATION DISORDER ♀
 Five dimensions for the assessment and diagnosis:min 1 v/d volgende hebben
- Percentage success of vaginal penetration
- Pain with vaginal penetration
- Fear of vaginal penetration or of genito-pelvic pain during vaginal penetration
- Pelvic floor muscle dysfunction
 Contractie BBS tijdens seks
- Medical comorbidity


2. ERECTILE DISORDER ♂
 = a recurrent inability to achieve or maintain an adequate erection during partnered sexual activities
 The diagnosis requires persistence of at least one of the three following symptoms 75-100% of the time during
sexual activity
- Struggle to achieve an erection during sexual activity
- Struggle to maintain an erection until the completion of sexual activity
- Noticeable decrease in erectile rigidity

 Technical aspect niet gezien
 You need:
 Rigidity/swelling
 Duration
 Erection “oprichting”
→
score this on 10-point scale & compare with situation before surgery (10/10)
- On what point do you need assistance

 But also functional niet gezien
- Situation related
- Partner related
- …




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, Physioth. Theory: pelvic reëducation in neuroP: sexual disorders
SEXUAL DISORDERS
 Disorder: refers to objective and subjective dysfunctioning of sexual interactions
- Need to take into account the somatic and psychological aspect
 Sexual difficulties↑ with age

HUMANS ARE SEXUAL BEINGS
 Humans have sexual identity
 Sexual problems cause
- Higher risk of fear, depression and lower self-esteem
- Negative effect on QoL
- Relational problems
- …

ANATOMY
1. MUSCLES
 Muscles important for normal sexual function (cfr. Lecture 1)
- M. ischiocavernosus
 Female : erection of the clitoris and restriction of venous outflow
 Male: erection of the penis and restriction of venous outflow
 M. bulbocavernosus/bulbospongiosus
 Female: closing of the vaginal hiatus-rhythmic contractions during orgasm-compression on the
deep dorsal vein (erection of the clitoris)
 Male: erection- rhythmic contractions during orgasm- evacuation of sperm from the urethra
 M. levator ani
 Male: erection of the penis- maintenance of blood supply in corpora cavernosa of penis
 M. sphincter ani externus
 Female and male, rhythmic contractions during orgasm

2. BLOOD SUPPLY
 Blood in penis, needs to stay there to maintain the erection




1. FEMALE SEXUAL ORGANS – CLITORIS
 Ook bulbocavernosa zoals penus
- Corpus cavernosa?
 Clitoris = zwellichaam + hard zwellichaam -> groot orgaan!




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, Physioth. Theory: pelvic reëducation in neuroP: sexual disorders

1. MALE SEXUAL ORGANS




PHYSIOLOGY OF THE (MALE) ERECTION
 Figuur
- GMP=guanosine mono fosfaat
- Compression of venular plexuses
 Inhibit venous return



 PNS initiates the erection and urination
 ONS initiates ejaculation
 Impossible to urinate and ejaculate at the
same time!

SEXUAL RESPONS CYCLE




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