sexuality + health promotion ❤

sexual health

is an essential element of overall health and wellbeing that healthcare providers and patients often do not discuss

while many patients have sexual history questions and want a providers insight....

they may be hesitant to start the conversation

by asking adult and adolescent patients a few essential questions you helped remove

the stigma around discussing sex and normalizing these discussions

a sexual history should be taken as part of

our routine health care as well as when there are s/s or physical exam

when assessing a pts sexual health you will look at

social history + and get a complete health picture

when obtaining a complete health picture you will ask about

sexual preferences + sexual practices + sexual identity when dealing with sexuality + also health and risk promotion!

health promotion education includes

support groups + educate about condoms and contraceptives

normal erectile function includes

nerve stimulation of blood flow into corpus cavernosum + the rapid influx of blood causes the penis to straighten and expand + the higher rate of blood flow into corpus cavernosum and a limitation in blood outflow are maintained in sexual arousal continues + balance of brain, emotions, hormones, nerves, muscles and blood vessles leads to normal male sexual arousal

erectile dysfunction (ED)

repeated inability to initiate or maintain an erection sufficient for sexual intercourse

erectile dysfunction (ED) pathophysiology

disruptions in the complex interplay between the vascular + neurological + hormonal and psychological systems

the most common biologic cause of ED is

neurological and vascular disorders such as neuropathy from diabetes mellitus and or atherosclerosis of penial arteries

ED becomes more common

as men age but simply growing older is not the primary cause of ED + men of any age can occasionally experience ED which should not cause excessive concern

the prevalence of ED increases

with age from 8% of men in 20's and 30's + 18% of men in 50's + 25% of men in 60's + 37% of men in 70's + 80% of men in 80's (true incidence of ED is higher due to under reporting of condition)

about 40% of cases of ED in men that are older than 50 are attributed to

atherosclerosis + diabetes + neuropathy + vascular disease

risk factors of ED include

chronic depression + anxiety + PTSD + intrapersonal or intimacy issues + strict upbringing + inadequate sex education + life stressors + surgeries such as prostatectomy and or radiation therapy due to prostate or colon cancer + smoking + alcohol + low energy levels

what are the 2 biggest risk factors for ED?

PTSD and STRESS

again the medical diagnoses that impact risk of ED include

diabetes + hypertension + hyperlipidemia + atherosclerosis + chronic liver failure + COPD + genetics + obesity + poor diet + chronic insomnia or sleep related disorders + low testosterone (hypogonadism) + decreased sexual energy (low libido) + mood disturbances

clinical presentation of ED should include

patient history + laboratory tests + other diagnostics

laboratory tests to assess ED include

testosterone levels + urinalysis + renal function

ED t/x includes

referral to urology or ED speciality to evaluate physiological causes + risk and benefits of non invasive t/x + pharmacological t/x

PDE-5 Inhibitors for ED

sildenafil and tadalafil (think meds ending in -fil help fill the penis with blood to get erect)

PDE-5 Inhibitors are CONTRAINDICATED when

taking nitroglycerin for heart conditions

PDE-5 Inhibitors are used with CAUTION in men using

alpha adrenergic blockers (tamsulosin (flomax) in those that had a myocardial infarction in past 6 months + resting hypotension + uncontrolled hypertension

tamsulosin (flomax) is used for

BPH to help urine flow

PDE-5 Inhibitors side effects

headache + flushed feeling + nasal congestion + mild visual disturbances + priapism

priapism

a painful erection that lasts 4 hours or more but is not accompanied by sexual excitement

testosterone (pharmacological t/x)

it is only effective if ED is caused by clinically low testosterone (hypogonadism). even then, TRT primarily improves libido (sex drive) and may only slightly enhance the effectiveness of erection

family planning is defined as

the spacing of conception of children according to wishes of the parents rather than to chance + accomplished by practicing some form of birth control

people may choose different contraceptive methods based off

safety + effectiveness + availability + side effects + user control + ease of removal or discontinuation

contraception (birth control) should be chosen via

voluntary and informed choices

most contraceptive methods DO NOT protect against

STI including HIV

using condoms can help protect

against HIV and other STI's

IUD (intrauterine device)

placed inside uterus by a doctor + works by releasing a small amount of progestin each day to keep you from getting pregnant + typically stays from 3 to 10 years

implant

single thin rod that is inserted under the skin of a women's upper arm + rod contains a progestin that is released into the body over 3 years

injection or birth control shot

women get shots of hormone progestin in buttock or arm every 3 months + can be self or provider administered

combined oral contraceptives (the pill)

combination of estrogen and progestin hormones + prescribed by doctor + taken daily at the same time + if you are older than 35 y/o and smoke, have a h/x of blood clots or breast cancer your doctor may advise you against taking it

progestin only pills (mini pill)

only contains progestin and NO estrogen + taken daily at the same time + good option for women who can not take estrogen

birth control patch

worn on the lower abdomen, buttocks, upper body but NOT breasts + prescribed by a provider + releases estrogen and progestin hormones to the blood stream via topical route + new patch 1x a week for 3 weeks and during 4th week they will NOT wear it so they can have a menstrual period

hormonal vaginal contraceptive ring

ring releases the hormones progestin and estrogen + place the ring inside your vagina + you wear the ring for three weeks, take it out for the week you have your period and then put in a new ring after cycle

diaphragm or cervical cap

before sexual intercourse the diaphragm or cervical cap is inserted in the vagina with spermicide to block or kill sperm + prescribed by provider

male condoms

covers the penis + keeps sperm out of the vagina + latex condoms (most common type) help protect against STI's and HIV + available OTC

female condoms

internal and help prevent pregnancy by blocking sperm getting to the egg + packaged with lubricant + available OTC + can be inserted up to 8 hours before intercourse + might help prevent STI's

calendar rhythm method

takes account of variability in the length of a woman's menstrual cycles + can help plan to get pregnant or avoid getting pregnant

coitus interruptus

pull out method

surgical contraceptive methods

tubal ligation ("tying the tubes") fallopian tubes are tied, closed or cut so sperm and eggs can not meet for fertilization (can be same day surgery or out patient hospital) also effective immediately + vasectomy is done to keep sperm from going to the penis so ejaculate never has any sperm in it that can fertilize an egg (outpatient surgical center) follow up after 12 weeks to ensure sperm count has reached 0!

fertility pattern is

number of days of the month when you are fertile + days you are not fertile + days when in fertility is unlikely but possible + if you do not want get pregnant do not have sex on days you are most fertile or use some sort of contraceptive method

infertility

the inability to conceive a child or get pregnant after 1 year or longer after having unprotected sex

infertility statistics

in the US 1 in 5 married women ages 15-49 y/o women with no prior births are unable to get pregnant after 1 year or longer after having unprotected sex + 1 in 4 in this group have difficulty getting pregnant and or carrying it to term

conditions that can contribute to infertility include

polycystic ovary syndrome + diminished ovary reserve + impaired function of the hypothalamus and pituitary glands + premature menopause + fallopian tube obstruction + abnormalities of the uterus

what increases risk of infertility in women?

age + smoking + excessive alcohol use + obesity + underweight + EXTREME weight gain or loss + excessive emotional or physical stress that results in absent periods

infertility in men

disruption of testicular or ejaculatory function + hormone and genetic disorders

t/x options of infertility include

timed intercourse + medications + intrauterine insemination + surgery + assisted reproductive technology

menopause

when a women has not had a menstrual cycle in more than 1 year + normal part of aging + mainly occurs in women 40 to 58 y/o

before age of 40 woman can experience

perimenopause! s/s that mirror menopause

menopause occurs when

estrogen and progestin hormones become lowered + ovaries stop releasing eggs when hormones are too low

what other factors may cause menopause to occur

having surgery to remove the uterus or ovaries + cancer t/x

early menopause

when a women before 40 has not had a menstrual cycle in more than 1 year

early menopause risk factors include

smoking + cancer t/x + having surgery to remove the uterus or ovaries + use of oral bc + low body fat + having a mother who has been given DES when pregnant

DES is

diethylstilbestrol a synthetic estrogen medication

menopause s/s

may be asymptomatic + can effect every body system + irregular periods + hot flashes + night sweats + problems sleeping like insomnia + vaginal dryness + discharge + itching + pain w/sex

women who do not have many symptoms

have them leading up to menopause

menopause diagnosis includes

provider asking about symptoms + past health + physical exam + asking about periods + blood test may be done to look for follicular stimulating hormone (FSH)

high levels of FSH suggest

menopause

t/x of menopause

NONE it is apart of normal life so just manage hormones with medicine and general care

HRT's (hormone replacement therapy)

such as estrogen + progesterone or testosterone class of medications that can be used for a short time as pills and injections (used to ease s/s of menopause) + but INCREASES RISK OF BREAST CANCER!

non hormone options include

certain bp meds + antidepressant meds + antiseizure meds (used to ease s/s of menopause)

self care t/x of menopause

balanced diet (veggies + fruit + whole grains) + regular physical activity each day + relaxation methods to ease stress + good sleep habits + no smoking + moderate or no alcohol + vaginal lubricants for dryness + thin layer to help with night sweats + cool drinks or cooling towels to help heat flashes

menstrual cycle

a monthly series of changes the body goes through in preparation for the possibility of pregnancy + each month one of the ovaries releases an egg (ovulation) + hormonal changes at this time get the body ready for pregnancy + if the released egg is fertilized during ovulation then the lining of the uterus sheds through the vagina (period)

on average, the normal menstrual cycle is one in which a woman menstruates is

every 28 day (varies in length)

menstrual dysfunction includes

absent periods + heavy menstrual bleeding + irregular periods + painful periods + light periods + prolonged bleeding + bleeding between periods

causes of menstrual dysfunction include

hormonal imbalances + stress + eating disorders + excessive exercise + certain medications + uterine fibroids + endometriosis + thyroid issues + pelvic inflammatory disease

STI's have a

direct impact on sexual and reproductive health through stigmatization + infertility + cancer + pregnancy complications and can increase risk of HIV

drug resistance is a major threat to reducing

the burden of STI's worldwide

more than 1 million curable STI's are acquired

every day worldwide in people between the ages of 15 and 49 + majority is asymptomatic

prevention of STI's includes

condoms are most effective prevention method when used correctly and consistently

s/s of STI's include

mainly asymptomatic but when s/s occur they can be non specific

diagnostic for STI's includes

molecular technology that is widely used in high income countries mainly used in asymptomatic infections

t/x of bacterial STI's (chlamydia + gonorrhea + syphilis + trichomoniasis) are generally curable with

SINGlE DOSE regimen of antibiotics

trichomoniasis is actually a

parasitic STI

herpes and hiv t/x is

antivirals (-vir) medications that can modulate the course of the disease but can NOT cure

hep b t/x

antivirals can help fight the virus and slow damage to the liver