Physiotherapeutic theory for neurological rehabili
Summary
Summary physiotherapeutic theory: sexual disorders (pelvic rehab)
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Course
Physiotherapeutic theory for neurological rehabili
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the sexual disorders lesson in the pelvic rehab section given by prof. I. Geraerts of the physiotherapeutic theory course. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as pos...
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
- …
Nala Melis Pagina 1
, 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!
Nala Melis Pagina 2
, 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
Nala Melis Pagina 3
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