Sexuality

25 important questions on Sexuality

Name 9 direct factors influencing sexual functioning

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Name 7 indirect influences on sexual behavior

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What is important to realize in sexuality with regard to the biopsychosocial approach

Functioning in one domain can affect functioning in other domains
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Name 4 cognitive functions affecting sexuality and explain shortly.

1. Increased distractability

2. Attention deficits, might affect arousal as it reduces one’s ability to maintain focus and to fantasize

3. Memory deficits, Patients might forget dates, recent sexual encounters, significant episodes with regard to a relationship

4. Difficulties in appropriate social interaction/social cognition, Social interaction might be inappropriate and signals wrongly interpreted

Name 7 psychological factors influencing sexuality

1. Changes in body image
2. loss of identity
3. adjustment issues
4. depression
5. anxiety   
6. confidence level and comfort
7. personality change (risk-taking)

What is the medical and physical issue in sexuality in TBI

Both global amount of brain tissue destroyed and focality of injuries might determine sexual outcome

What symptoms in TBI might interfere with sexuality?


§Limitations in functional mobility
§Headaches
§Fatigue
§Pituitary dysfunction
§Spasticity
§Impaired balance
§Hemiparesis or hemiplegia
§Tremor
§Ataxia
§Dizziness
§Incontinence

What is the influence of medication on sexuality


Many frequently prescribed medications (e.g. antihypertensives, antidepressants, stimulants or anticonvulsants) might interfere with sexual functioning (side effects such as decreased libido or orgasmic difficulties)

How does TBI change a relationship

1. Sequelae of TBI (physical, cognitive, emotional and behavioral changes) often places significant demands on families (Consequences: depression, social isolation, etc.)

2. Role changes and increased dependence of the injured partner
 
3. Social skills deficits might lead to communication difficulties or emotional distance within relationships

Name sexual disorders following stroke

1. Decline in sexuality after stroke
2. partner dissatisfaction

Besides the stroke, what are other consequences that lead to sexual disorders

1. psychosocial issues and depression are likely to contribute


2. Many of the antihypertensive agents commonly given to stroke patients inhibit erections; some drugs (e.g. β-blockers) also reduce desire

What is unique about sexuality in epilepsy?

Unique in its ability to provoke involuntary sexual gestures. §Sexual automatisms (e.g. sexual statements, grabbing, simulated intercourse or masturbation) as an expression of complex partial seizures (usually arising from the temporo-limbic circuitry). Frequency possibly under-reported since amnesia commonly accompanies such automatisms

What do pt. of epilepsy experience besides and indepedent of sexual automatisms (ictal manifestations)?

Patients may experience sexual auras, erotic feelings and/or genital sensations as part of complex partial seizures. This sexual excitement can proceed to spontaneous orgasm (more often in women). Women who have ictal orgasms tend to be profoundly hyposexual between their seizures

How does sexuality in epilepsy manifests interictal


Most common interictal sexual dysfunction associated with TLE is hyposexuality

Explain association antiepileptic drug and sexuality

Association between sexual dysfunction and exposure to antiepileptic drugs

Explain association epilepsy surgery and sexuality

Postoperative sexual change was significantly more likely in patients undergoing temporal resection (64%) than non-temporal resection (25%). TLE patients typically reported a sexual increase to a perceived level of ‘‘normal’’ functioning

What are major determinants in dissatisfaction in sexuality in pt of parkinson disease?

1. Age
2. severity of disease
3. depression

What is observed in pt Parkinson following treatment with antiparkinsonian medications and deep brain stimulaton

Hypersexuality

Name 5 secondary mechanisms in sexual dysfunction in MS

1. Fatigue

2. Weakness

3. Difficulty mobility

4. Bladder and bowel dysfunction

5. side effects MS medication

Name 5 tertiary influences sexual dysfunction MS

1. Negative self image or body image
2. Fear of being rejected sexually
3. Feeling of dependency
4. Communication difficulties with partner
5. Depression and anger

How is sexual dysfunction assessed. Name 2

1. Interview

2. Questionnaires such as psychosexual assessment questionnaire

What is recommended regarding intervention of sexual health?

Reduced self-image, fatigue, loss of independence, depression, and changes in interpersonal relationships
might damage sexual function as much as
the disrupted nerve circuits. Therefore:
any service designed to address sexual health
should also address relationship issues,
with inclusion of patients’ partners into treatment plans

What is the you and me sex education?

Developed to enable staff to provide education to patients with TBI

Name 2 mechanisms that may underly ISB and their assumed cause of lesions in brain

1. hypersexuality (associated with bilateral temporal lobe lesions

2. Sexual disinhibition (linked to injury frontal lobes)

What can be a  (far reaching) result of neglecting ISB and what can be done to avoid that?

patients are refused placement or care because of ISB

1. Importance of creating an environment with clear rules for patients and staff regarding sexual behaviors

2. Addressing ISB (clinicians who do not address ISB may be giving their "silent permission")

3.  Treatment of ISB (e.g. behavioral and cognitive approaches) 

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