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Summary theme 7
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Summary of 17 pages for the course Theme 7 at RuG (Checklist theme 7)
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Semester 2.2, theme 7Week 25, sex
Understand the concept of sexuality and sexual health.
Sexual health: the physical, psychological, interpersonal and social functions of sex
Determinants of sexual health:
1. Positive outlook on love, intimacy and sexuality
2. Permission and options to discover one’s own sexuality
3. A healthy body and a healthy mind that develop in an age-specific way at the same time
Sexual health already begins in week 24 of fetal life and throughout childhood it continues, mainly during REM sleep.
Cultural differences are really important.
0-3 y/o curious to discover their bodies
4-6 y/o asking questions about reproduction, pregnancy and birth
6-10 y/o feelings of shame and guilt about sex and intimacy
end primary school wanting to learn more about sex and are more interested
puberty and adolescence physical and emotional changes, wet dreams
If women wants to become pregnant: increased desire, excitement and frequency of sex
- in first trimester of pregnancy more emotional contact
- after delivery lower sexual excitement due to high [prolactin]
Understand the sexual response cycle.
* Bartholin’s glands: the only glands that play a role in the female sexual response
Know about the differential diagnose of sexual dysfunction in women.
DSM-5 describes sexual disfunction: symptoms need to be there for >6 months
- Female orgasm disorder: can be difficult to achieve or significantly reduced intensity of the orgasm can be physical
(DM, neurological ,MS) or psychological
- female sexual interest/arousal disorder (FSIAD): can be due to androgen deficiency, medication, depression…..
- Genito-pelvic pain/penetration disorder: 4 core symptoms difficulty on penetration, pelvic pain, general fear of
penetration, tensioning of pelvic floor muscles.
NOTICE: 25% of all disruptive sexual problems are caused by medication (SSRI’s, antipsychotic meds)
Know about the diagnose of sexual dysfunction in men.
Delayed ejaculation, erectile dysfunction, male hypoactive sexual desire disorder, premature ejaculation, unspecific
sexual dysfunction.
1
, Treatment in men and women: PLISSIT:
P=permission (discuss problem of issue), LI= limited information, SS= specific suggestions, IT= intensive therapy
mostly P and LI enough
Know about the of the health care system in case of sexual problems.
19% of men and 27% of women experience sexual problems
If there are problems regarding sexual health, the youth health care provides information, advice, referrals and
detection of sexual problems. The center for sexual health (CSG) is part of the GGD, and they offer STI tests. The
GP can also test for STIs and HIV. The CSG is for at-risk groups and for young people <25, for those, testing is for
free.
* the WPG sets GGDs responsible for preventing STIs and the spread.
* for high-risk groups: ASG plan is extra: centrum voor infectieziektebestrijding (CIb) of RIVM is responsible
* to promote sexual health, education about sex ins compulsory in the Netherlands.
Pre-exposure prophylaxix for HIV: prevent HIV in at risk groups, mostly MSM. Or if partner has HIV
prophylactic medicine (emtricitabine and tenofovir) reduces HIV risk through sex by 98%. They also need to be
tested every 6 months for the 5 most common STIs:
1. Chlamydia
2. Gonorrhea (most of MSM)
3. Syphilis (96% in MSM)
4. HIV (90% MSM)
5. Hepatitis B
Post-exposure prophylaxis for HIV: if they may have recently contracted HIV: 4 weeks HIV treatment
can be obtained from GP, GGD or first aid HIV center
Know about Gender Dysphoria and Gender Identity.
Gender dysphoria: gender identity disorder. This is no longer a sexual disorder, it is not found in the DSM-5!
Know about the principles of the support system in case of sexual problems.
Persons <25 years old can always contact Sense for anonymous questions. Otherwise, the CSG is available.
Know about the influence of hormones in the perception of sexuality.
Prolactin: fewer desire
Androgens: more desire
Know about the causes of gynaecological abdominal pain.
Endometriosis, chronic pelvic pain, menstruation, STI
Know about the differential diagnose of STI’s. SEE TABLE SLIMSTUDEREN
STIs are spread mainly through contact between mucous membranes
The big 5: syphilis, gonorrhea, chlamydia, hepatitis B and HIV
Notice: when there is a STI present, the person is more likely to get another STI due to a compromised immune system
HSV-2: appears around genitals. It is in the genome for life!
HSV-2 is more often reactivated than HSV-1.
if the patient is already HSV-1 +, then a primary HSV-2 infection is often asymptomatic.
primary episode is often worse than an recurrent infection
if mom has it 6 weeks before delivery: C-section prevents transmission
Symptoms: pain, vesicles, erosion, edema in the internal and external anogenital area
Diagnosis: NAAT can distinguish between HSV-1/2.
Treatment: not curative but suppressive: oral nucleoside
Candida vulvovaginitis: vulvar itching, redness and edema, watery discharge
Bacterial vaginosis (BV): overgrowth anaerobic bacteria (fish smell). Runny watery discharge.
Amsel criteria, 3 out of 4 for diagnosis:
2
, - white/grey discharge
- fishy smell
- pH > 4,5
- bacterial cells on fresh microscopy
Aerobic vaginitis and desquamative inflammatory vaginitis (AV): varies in severity
- severe: red, inflamed vagina with edema and yellowish brown discharge. Painful, burning sensation, dyspaneuria
Diagnosis: a score of >6 indicates severe
Chlamydia: most common bacterial STI in western countries. In transitional epithelium of cervix, urethra and rectum
vague symptoms or asymptomatic
if advanced, blindness and sexually active reactive arthritis can occur
Diagnosis: NAAT
Gonorrhea: only pathogenic to humans. In epithelium of urethra and paraurethral glands
asymptomatic or fever, rah, pustules, arthralgia. Eventually blindness can occur
Diagnosis: NAAT
Syphilis: transmitted via placenta or long skin-skin + mucous contact. It has several stages:
1) primary syphilis: painless ulcer
2) secondary syphilis: after 3-12 months: skin, mucous membrane, organ (liver, kidney) abnormalities may occur|
3) tertiary syphilis (28% gets it): after 15-20 years, irreversible neurological and cardiac complications occur
* in between = latent recurrence of secondary syphilis and symptoms occur is 25%
Diagnosis: microscopically or serologically
Know about the symptoms and differential diagnose of a Pelvic Inflammatory Disease (PID).
PID: an infection with inflammation of the female genitalia above the cervix.
Cause: mostly gonorrhea or chlamydia, but not always
Symptoms: bilateral lower abdominal pain, symptoms after menstruation, dyspareunia, vaginal blood loss, yellowish
green vaginal discharge
Diagnosis: gonorrhea and chlamydia test and if negative: microflora and complete mucoid leukocyte test.
Know about the principles of the system of partner-warning and -detection in case of STI’s.
It is regulated in the WPG. Public healthcare cannot oblige a patient to tell the partner i.c.o. a STI, this has to be
voluntarily. It can only be breeched if a third person comes in direct danger of life. For example when the partner is
pregnant and the baby is at risk.
Know about risk behavior and risk groups concerning sex
Risk behavior: not using condoms, not having any kind of contraception
Risk groups: MSM, prostitues, partner with STI. Persons < 25 have increased risk of chlamydia, but not of other STIs.
Know about the differences and similarities between the tasks/responsibilities of public health care and family
physicians
Public health care takes way more into consideration than the patients alone. It involves acts and regulations. The GP
needs to follow these regulations. Regarding responsibility: detect as early as possible = common goal.
Know about the epidemiology of sexual problems in the population.
Women: overall = 27%, dyspareunia (5%), orgasm problems (11%), decreased sense (3%), decreased arousal (10%)
Men: overall = 19%, erectile dysfunction (8%), premature ejaculation (10%)
Know about the indication for referral of patient with sexual problems.
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