Sexual Function and Pelvic Floor Dysfunction: A Guide for Nurses and Allied Health Professionals

✍ Scribed by Angie Rantell (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 201
• Category: Library

✦ Synopsis

This book provides to nurses an understanding of female sexual function and dysfunction specifically in relation to common gynecological conditions. It offers evidence based overview of assessment of sexual function, including available questionnaires and provides a multidisciplinary approach to managing sexual dysfunction, from incontinence to pelvic organ prolapse and recurrent urinary tract infections. It also covers a holistic approach including over the counter and home treatments, psychological therapies, physical therapies, pharmacological options and if necessary more invasive interventions.
Sexual function and pelvic floor dysfunction is often a neglected area due to the taboo nature of discussions. This book aims to educate nurses, to help them understand the types of treatment options available, and encourage them to engage in conversations about sexual function with women, so that they can be referred to appropriate healthprofessionals and access the right care.

✦ Table of Contents

Contents
1: Introduction
References
2: Models of Sexual Response
2.1 Introduction
2.2 Early Sexual Response Models
2.3 Physiological Changes in the Sexual Response Cycle
2.4 Further Development of Sexual Response Models
2.5 Key Points from Basson’s Model
2.6 Sexual Desire/Motivation
2.7 Conclusions
References
3: What Is Female Sexual Dysfunction?
3.1 Definitions/Classifications of Female Sexual Dysfunction (FSD)
3.2 Prevalence of FSD
3.3 Causes of FSD
3.4 Psychosocial Factors
3.5 Controversies in the Diagnosis of FSD in Women with Pelvic Floor Dysfunction
3.6 Conclusions
References
4: Impact of Incontinence on Female Sexual Function
4.1 Background
4.2 Causes of Lower Urinary Tract Symptoms
4.2.1 Urinary Incontinence
4.2.1.1 Overactive Bladder
4.2.1.2 Stress Urinary Incontinence
4.2.1.3 Mixed Urinary Incontinence
4.2.1.4 Other Causes of Urinary Incontinence
4.3 Investigation of Lower Urinary Tract Symptoms
4.4 Impact of Urinary Incontinence on Quality of Life
4.5 Urinary Incontinence and Sexual Function
4.5.1 Prevalence of Female Sexual Dysfunction
4.5.2 Impact of Urinary Incontinence on Sexual Function
4.5.3 OAB Versus SUI
4.5.4 Coital Incontinence
4.5.5 Sexual Pain Disorder
4.5.6 Impact of Intercourse on Urinary Symptoms
4.6 Management of Sexual Function in Women with LUTS
4.7 Conclusions
References
5: Impact of Pelvic Organ Prolapse on Sexual Function
5.1 Introduction
5.2 Aetiology of Pelvic Organ Prolapse
5.3 Symptomatology of POP
5.3.1 Summary Overview of Primary and Secondary Symptoms
5.4 Sexual Dysfunction in POP
5.5 Pathophysiology of Sexual Dysfunction in Women with Urogenital Prolapse
5.6 Physical Presence of Prolapse
5.7 Associated Local Pathology
5.8 Genito-Urinary Syndrome of Menopause [GSM]
5.9 Psychological Factors
5.10 Associated Incontinence
5.11 Confounding Factors
5.11.1 Menopause
5.11.2 Advancing Age
5.11.3 Dysfunctional Male Partner or Lack of a Partner
5.11.4 Pre-prolapse Sexual Dysfunction
5.11.5 Post-Partum Dyspareunia
5.12 Assessment of POP
5.13 Investigations in POP
5.14 Effect of Therapeutic Interventions
5.14.1 Coping Strategies
5.14.2 Pelvic Floor Muscle Training
5.14.3 Pessaries
5.14.4 Surgical Intervention
5.15 Conclusion
References
6: The Impact of Recurrent Urinary Tract Infections on Sexual Function
6.1 Definition of Urinary Tract Infection
6.2 Symptoms
6.3 Diagnosis
6.4 Definition of Recurrent Urinary Tract Infection (rUTI)
6.5 Uropathogens
6.6 Pathogenesis of rUTI
6.7 Prevalence
6.8 Risk Factors for UTI
6.9 Impact on Quality of Life
6.10 Treatment of UTI
6.11 Sexual Function
6.12 Conclusion
References
7: Genitourinary Syndrome of Menopause and Female Sexual Dysfunction
7.1 Introduction
7.2 Signs and Symptoms
7.3 Diagnosis
7.3.1 Physiological Changes
7.3.2 Patient Awareness and Understanding
7.3.3 GSM and Sexual Dysfunction
7.4 Treatment
7.4.1 Lubricants and Moisturisers
7.4.2 Physiotherapy
7.4.3 Homeopathic and Lifestyle Modifications
7.4.4 Oestrogen Therapy
7.4.5 Local Oestrogen Therapy
7.4.6 Systemic Oestrogen Therapy
7.4.7 Testosterone
7.4.8 Ospemifene
7.4.9 Dehydroepiandrosterone (DHEA)
7.4.10 Vaginal Laser
7.4.11 MDT
7.4.12 Differential Diagnosis of GSM
7.5 Conclusion
References
8: Introducing the Subject to Women
8.1 Introduction
8.2 Healthcare Professional Perspective
8.3 Barriers to Discussions
8.4 Current Practice
8.5 What About Those Who Are Not Sexually Active (NSA)?
8.6 Asking About Sexual Satisfaction/Frequency/Partners Awareness
8.7 LGBTQ+ Communities
8.8 Presence of a Partner
8.9 Who Should Ask the Questions?
8.10 Timing of Discussions
8.11 Initiating the Discussion: What Do Women Want?
8.12 Prewarning
8.13 Verbal Communication/Conversation Starters
8.14 Role of Questionnaires
8.15 Healthcare Professional Education
8.16 Conclusion
References
9: History Taking and Physical Examination
9.1 Sexual Pain Disorders
9.2 Desire, Arousal, and Orgasm Disorders
9.3 Pelvic Floor Dysfunction
9.4 History Taking
9.4.1 Medical History
9.4.2 Medication History
9.5 Physical Exam
9.5.1 Vulvoscopy
9.5.2 Sensory Exam
9.5.3 Manual Exam
9.5.4 Speculum Exam
9.6 Summary
References
10: Subjective and Objective Measure of Sexual Function in PFD
10.1 Introduction
10.2 Clinical History and Examination
10.3 Assessment of Quality of Life
10.4 Generalized Questionnaires to Assess FSD
10.5 Female Sexual Function Index (FSFI)
10.6 Golombok-Rust Inventory of Sexual satisfaction [GRISS]
10.7 Condition-Specific Questionnaire to Assess FSD in Women with PFD
10.8 International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms Sex (ICIQ-FLUTSsex)
10.9 Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ)
10.10 The Impact of Pelvic Floor Dysfunction on Sexual Function
10.11 Effects of Gynaecologic Surgeries on Sexual Function
10.12 Conclusion
References
11: Over the Counter and Home Remedies
11.1 Vaginal Dryness
11.2 Lubrication
11.2.1 Water-Based Lubrication
11.2.2 Oil-Based Lubrication
11.2.3 Vaginal Moisturisers
11.2.4 Topical Vaginal Oestrogens
11.3 Dyspareunia
11.3.1 Dyspareunia Due to Vaginal Dryness
11.3.2 Vulvodynia
11.3.3 Endometriosis
11.3.4 Post Brachytherapy
11.4 Incontinence
11.4.1 Pelvic Floor Exercises
11.4.2 Intravaginal Support Devices
11.4.3 Weight Loss
11.4.4 Sexual Positions
11.5 Prolapse
11.5.1 Sea Sponges
11.5.2 Sexual Positions
11.5.3 Internet and Chat Rooms
11.5.4 Support Devices
11.6 Low Libido
11.6.1 Food
11.6.2 Essential Oils
11.6.3 Sex Toys and Other Erotica
11.7 Lack of Research
11.8 Women and the Internet
11.8.1 Other Ways of Getting Information
11.9 Conclusions
References
12: Psychosexual Therapy for Female Sexual Dysfunction (FSD)
12.1 Introduction
12.1.1 Psychosexual Therapy
12.1.1.1 Assessment/History
Relationship
Negative Behaviours
Previous Treatments
12.1.1.2 Medical History
Goal Setting
12.1.1.3 Education
12.1.1.4 Formulation
12.1.1.5 Structured Behavioural Assignments Often Used in Sex Therapy
Sensate Focus
Systematic Desensitisation
12.1.1.6 Assessment of Sexual Pain
12.1.1.7 Questions to Consider
12.1.1.8 Assessment of Sexual Interest/Arousal
12.1.1.9 Questions to Consider
12.1.1.10 PLISSIT: A Sexuality Assessment and Intervention Tool
12.2 Conclusion
References
13: Physical Therapies
13.1 Brief Summary
13.2 Introduction
13.3 Pathophysiology
13.4 Hypothesis
13.5 Methods
13.6 Results
13.6.1 Classifications and Models
13.6.2 Physiotherapeutic Assessment and Treatment
13.6.3 Physical Exam
13.6.4 Treatment
13.7 Scientific Evidence for Pelvic Physiotherapy
13.8 Conclusions
References
14: Pharmacological and Surgical Management
14.1 Background
14.2 Pharmacological Management
14.2.1 Hormone Replacement
14.2.1.1 Oestrogen
14.2.1.2 Intravaginal Prasterone (Intrarosa®)
14.2.1.3 Ospemifene (Senshio®)
14.2.1.4 Tibolone
14.2.1.5 Testosterone
14.2.2 Vasodilators
14.2.3 Centrally Acting Drugs
14.2.4 Muscle Relaxants
14.2.5 Vitamin Supplementation
14.3 Drug Treatment for Other Conditions Causing FSD
14.3.1 Vulval Disease
14.3.2 Benign Gynaecological Disorders
14.3.3 Urological
14.4 Surgical Management
14.4.1 Surgical Treatment of Pelvic Organ Prolapse (POP)
14.4.2 Surgical Treatment of Urinary Incontinence
14.4.3 Hysterectomy for the Treatment of Benign Gynaecological Disease, e.g. Dysfunctional Uterine Bleeding, Endometriosis
14.4.4 Vestibulectomy
14.4.5 Fenton’s Procedure
14.4.6 Trigger Point Injections
14.4.7 Botox® Injections to the Pelvic Floor Muscles
14.4.8 Lasers
14.5 Recommendations for Treatment
14.6 Conclusions
References
15: The Impact of Partner/Male Sexual Problems on Female Sexual Function
15.1 Introduction
15.2 Erectile Dysfunction
15.2.1 Medical History
15.3 Ejaculatory Dysfunction
15.3.1 Premature Ejaculation
15.3.2 Delayed Ejaculation
15.4 Male Hypoactive Sexual Desire Disorder
15.4.1 Masturbation
15.4.1.1 Physical and Psychological Benefits
15.4.1.2 Male Masturbation
15.4.1.3 Female Masturbation
15.4.1.4 The Impact of Male Sexual Difficulties
15.4.1.5 The Impact of Female Sexual Difficulties
15.5 Conclusion
References
16: Access to Services and Help-Seeking Behaviour
16.1 Introduction
16.2 Factors Associated with Help Seeking
16.3 Factors That Hinder Help Seeking
16.4 Access to Services
16.5 Conclusions
References