What is Dyspareunia?

 Vaginal pain after sexual intercourse.

 Painful sexual intercourse.
 CAUSES Dyspareunia
 Poor vaginal lubrication
 Reduced libido
 Reduced estrogen
 Vaginal dryness
 Inadequate foreplay
 Menopause
 Perimenopause
 Lactation - causes vaginal dryness
 Dyspareunia

 Post-childbirth
 Episiotomy - if performed for childbirth
 Vaginal infection
 Cystitis
 Urethritis
 Vaginal infection
 Vulva infection
 Atrophic vaginitis
 Vaginal changes from childbirth
 CAUSES Dyspareunia

 Narrow vaginal
 Hymen
 Psychological disorders
 Anxiety
 Vaginismus
 Endometriosis
 Hemorrhoids
 CAUSES Dyspareunia

 Pelvic infection
 Pelvic inflammatory disease
 Genital tract tumor
 Vaginal tumors
 Vaginal surgery
 Pelvic disorders
 Sexual organ disorders
 Some causes of deep penetration intercourse pain in women
include:
 Pelvic inflammatory disease
 Pelvic tumor
 MANAGEMENT Dyspareunia
 History and physical examination with pelvic and rectal
exams
–Timing: Onset (e.g., upon entry, after intercourse),
duration, persistence after intercourse, prior
occurrence(s)
–Associations: Symptoms may occur with all vaginal or
vulvar contact, with intercourse only, with exams only,
with masturbation, or with memories or recollections of
prior occurrences or traumatic experiences
–Alleviating and aggregating factors during intercourse
–Qualifiers: Burning, sharp, dull, aching, throbbing,
stabbing
–Include complete psychiatric history and exam
 Vaginismus:
 Vaginal entrance muscle spasms triggered
by sex
 Involuntary contraction of muscle at the
outlet of the vagina when coitus is
attempted prohibiting penile penetration or
during sexual intercourse.
 CAUSES

Fear of sex
Unpleasant sexual experience
Negative attitude to sex
TREATMENT

PSYCHOLOGICAL
COUNSELLING
Prognosis of Vaginismus

Most women recover to normal

sex life and motherhood with
treatment.
 FRIGIDITY

Loss of libido
Sexual aversion disorder
 Signs / symptoms
 Loss of female libido
 Lack of enjoyment of intercourse
 Painful intercourse
 Vaginal dryness
CAUSES

1. Organic
2.Functional
 Organic
 Malformation
 Imperforate hymen
 Vaginal stenosis
 Hermaphroditism
 Retroverted uterus
 Turner syndrome-the normal XX sex
chromosomes for a female, only one X
chromosome is present(45X0) . female sexual
characteristics are present but generally
underdeveloped.
 Organic
 Inflammation
 PID
 Cystitis
 Anal fissure
 Vaginitis
 Salphangitis
 endometeritis
 Organic
 Trauma
 Enlarge male organ
 Masturbation
 Sexual molestation/raped
 Functional Cause
 Psychological cause
 Fear or hostility regarding intercourse
 Anxiety : previous rape
 Marital difficulties
 Diagnostics
 Pelvic & rectal exam
 Chromosomal analysis if indicated
 Hormonal analysis
 FSH
 Estradiol

 UTZ/ vaginal smear & culture

 Gynecologic exam
 Treatment
 Treat the cause
 Estrogen therapy as prescribed
 Psychiatrist
 Emotional support
MALE REPRODUCTIVE SYSTEM: ANDROLOGY

B. Penis: the male organ of copulation; a cylindrical

shaft consisting of:
a. corpora cavernosa -two lateral columns of
erectile tissue
b. corpus spongiosum - encases the urethra
Parts: 1.The glans penis, a cone-shaped expansion of
the corpus spongiosum that is highly sensitive in
males.
2. Shaft or body
3. Prepuce or Foreskin – retractable skin
covering the glans & removed during circumcision.
Unretractable or tight foreskin is called
PHIMOSIS.
-Erection is stimulated by parasympathetic nerve
C. Scrotum: a pouch hanging below the penis
that contains the testes.
INTERNAL STRUCTURES:
A.TESTES
= TWO OVOID SHAPED BODY THAT LIE
INSIDE THE SCROTUM
= ENCASED BY A PROTECTIVE WHITE
FIBROUS CAPSULE AND COMPRISES A
NUMBER OF LOBULES
= EACH LOBULE CONTAINS INTERSTITIAL
CELLS ( LEYDIG’S CELLS) AND SEMINIFEROUS
TUBULES
= SEMINIFEROUS TUBULES PRODUCE
SPERMATOZOA
= LEYDIG’S CELLS PRODUCE THE HORMONE
TESTOSTERONE
FUNCTIONS OF THE TESTES:
1. SPERMATOGENESIS
= PROCESS BY WHICH THE
SPERMATOCYTES ARE DEVELOPED INTO
MATURE SPERMATOZOA
2. HORMONE PRODUCTION
a. TESTOSTERONE = AN ANDROGEN OR
MUSCULINIZING HORMONE RESPONSIBLE
FOR
** GROWTH & DEVELOPMENT OF
SECONDARY SEX CHARACTERISTICS
b. FSH = FOLLICLE STIMULATING HORMONE
= CAUSES RAPID SPERM PRODUCTION BY
THE TUBULE
c. ICSH – INTERSTITIAL CELL STIMULATING
HORMONE
= STIMULATES LEYDIG’S CELLS TO
INCREASE TESTOSTERONE PRODUCTION
 Spermatogenesis
Testes

Contain Leydig cells produces testosterone

Testosterone ALERT: it takes 64 days

for sperm to reach
maturity
Stimulates
APG secrete FSH & LH
stimulates seminiferous tubules to produce
spermatozoa
 Sperm Pathway
 Testes ---produces sperms

 Epididymis conducts sperm to Vas deferens

 Seminal vesicles ( secretion of fructose & protein)

 Ejaculatory duct

 Urethra ( 8 inches) ( cowper’s gland secretes

alkaline fluid)

 OUT
Male
MALE REPRODUCTIVE SYSTEM:
B. Internal Structures

1. Epididymis: serves as reservoir for sperm storage and

maturation. Approximately 20 ft. it takes 12-20 days for
the sperm to travel the length of Epididymis.

A total of 64 days before they reach maturity.

(“Treatment= 2 months”).
Aspermia - (absence of sperm)
Oligospermia- if < 20 million sperm/ ml

2. Vas deferens: a duct extending from epididymis to the

ejaculatory duct and seminal vesicle, providing a
passageway for sperm.
Varicocele- varicosity of internal spermatic cord
Vasectomy (male birth control)

3. Seminal vesicle: are two convoluted pouches that lie along

the lower portion of the bladder and empty into the urethra
by the way of ejaculatory ducts
MALE REPRODUCTIVE SYSTEM:

4. Ejaculatory duct: the canal formed by the union of

the vas deferens and the excretory duct of the
seminal vesicle, which enters the urethra at the
prostate gland.

5. Prostate Gland: located just below the urinary

bladder. Secretes alkaline and most of the seminal
fluid.

6. Bulbourethral glands or Cowper’s Gland: adds

alkaline fluid to the semen. Counterpart of the
Bartholin’s glands in females.

7. Urethra: the passageway for both urine and semen,

extending from the bladder to the urethral meatus.
(8 inches in long)
SEMINAL FLUID / SEMEN:
= A GRAYISH WHITISH SUBSTANCE
CONTAINING SPERMATOZOA AND FRUCTOSE
RICH SUBSTANCES.
= AT THE TIME OF EJACULATION,
APPROXIMATELY 3-5 ML OF SEMEN IS
SECRETED WITH ABOUT 100 MILLION
SPERMATOZOA PER ML, OR ABOUT 250-500
MILLION SPERMATOZOA AT EACH
EJACULATION. IF THE SPERM COUNT DROPS
TO LESS THAN 20 MILLION PER ML OF
SEMEN, THE RATE IS CONSIDERED
INFERTILE.
SEXUAL DYSFUNCTION
IN MALE
Erectile dysfunction
Impotence
 Erectile dysfunction
(Impotence)
 Inability of the man to produce or maintain
erection , long enough for vaginal penetration
or partner satisfaction.
 Formerly called impotence
 Causes
 Physical cause
 Common causes of erectile dysfunction
include:
 Heart disease
 Clogged blood vessels (atherosclerosis)
 High blood pressure
 Diabetes
 Obesity
 Metabolic syndrome
 Causes
 Other causes of erectile dysfunction include:
 Certain prescription medications
-antidepressants, antihistamines and medications
to treat high blood pressure, pain and prostate
cancer
 Tobacco use
 Alcoholism and other forms of drug abuse
 Treatments for prostate cancer
 Parkinson's disease
 Multiple sclerosis
 Hormonal disorders such as low testosterone
(hypogonadism)
 Surgeries or injuries that affect the pelvic area or
spinal cord
 Psychological causes of erectile dysfunction
The brain plays a key role in triggering the series of
physical events that cause an erection, beginning
with feelings of sexual excitement. A number of
things can interfere with sexual feelings and lead to
— or worsen — erectile dysfunction. These can
include:
 Depression
 Anxiety
 Stress
 Fatigue
 Poor communication or conflict with your partner
 Ultrasound. This test can check blood flow to
your penis.
 Neurological evaluation.
 Dynamic infusion cavernosometry and
cavernosography (DICC).
 This procedure involves injecting a dye into penile
blood vessels to permit view any possible
abnormalities in blood pressure and flow into and
out of your penis. It's generally done with local
anesthesia by a urologist who specializes in
erectile dysfunction.
 Nocturnal tumescence test.
 A simple test that involves wrapping a special
perforated tape around the penis before going to
sleep can confirm whether you have erections
while you're sleeping. If the tape is separated in
the morning, your penis was erect at some time
during the night. Tests of this type confirm that
there is not a physical abnormality causing erectile
dysfunction, and that the cause is likely
psychological.
 Oral medications
Oral medications available to treat ED
include:
 Sildenafil (Viagra)
 Tadalafil (Cialis)
 Vardenafil (Levitra)
 ACTION :
 Chemically known as phosphodiesterase
inhibitors, these drugs enhance the effects of
nitric oxide, a chemical that relaxes muscles in
the penis. This increases the amount of blood
flow and allows a natural sequence to occur —
an erection in response to sexual stimulation.
 Hormone replacement therapy
For the small number of men who have testosterone
deficiency, testosterone replacement therapy may be an
option.
 Penis pumps
 This treatment involves the use of a hollow tube with a
hand-powered or battery-powered pump. The tube is
placed over the penis, pump is used to suck out the air.
This creates a vacuum that pulls blood into the penis.
 Once you achieve an adequate erection, slip a tension
ring around the base of the penis to maintain the
erection. then remove the vacuum device. The erection
typically lasts long enough for a couple to have sex.
remove the tension ring after intercourse.
 Vascular surgery
This treatment is usually reserved for men whose blood
flow has been blocked by an injury to the penis or pelvic
area.
 The goal of this treatment is to correct a blockage of
blood flow to the penis so that erections can occur
naturally. But the long-term success of this surgery is
unclear.
 Penile implants
The inflatable device allows to control when and
how long you have an erection, These implants
consist of either an inflatable device or semirigid
rods made from silicone or polyurethane. This
treatment is often expensive and is usually not
recommended until other methods have been
considered or tried first. As with any surgery, there
is a small risk of complications such as infection.
 Psychological counseling and sex therapy

 Stress, anxiety or depression is the cause of erectile

dysfunction
 Counseling can help, especially when your partner
participates.
 Nursing care
 Patient education
 Limit or avoid the use of alcohol.
 Avoid illegal drugs such as marijuana.
 Stop smoking.
 Exercise regularly.
 Reduce stress.
 Get enough sleep.
 Get help for anxiety or depression.
 advised regular checkups and medical screening
tests.
 Communicate with patient and partner openly
MENOPAUSE = PERMANENT CESSATION OF
MENSTRUAL CYCLES THAT OCCURS
BETWEEN 45 & 55 Y/O; ave: 50y/o

= THE POINT AT WHICH NO

FUNCTIONING OOCYTES REMAIN IN THE
OVARIES
S/SX OF MENOPAUSE:
1.HOT FLASHES – SENSATION OF HEAT THAT
BEGINS IN THE FACE TO THE CHEST & PROFUSE
PERSPIRATION.
2. LOSS OF BREAST MASS & FIRMNESS, ATROPHY
OF REPRODUCTIVE ORGANS.
3. DYSPAREUNIA ( PAINFUL INTERCOURSE) DUE TO
DECREASED VAGINAL LUBRICATION.
4. OSTEOPOROSIS - ESTROGEN PROMOTES
CALCIUM DEPOSITION IN THE BODY. A FALL IN
ESTROGEN LEVELS WILL LIBERATE CALCIUM
FROM THE BONES MAKING THEM BRITTLE
MX:
1. ESTROGEN REPLACEMENT THERAPY ( HRT; ERT)
2. CALCIUM ( 1g/DAY AT HS) & VIT. D
SUPPLEMENTATION
3. LIBERAL FLUID INTAKE TO DILUTE URINE AS
MORE CALCIUM IS LIBERATED FROM THE BONES
& COULD CAUSE RENAL CALCULI.
4. WEIGHT BEARING EXERCISES
MX OF HOT FLASHES:
2. DRESS IN LAYERED LOOK, REMOVE OUTER
CLOTHING DURING ATTACKS.
2. AVOID HOT ENVIRONMENT
3. AVOID EMOTIONAL STRESS
4. AVOID FOODS THAT COULD TRIGGER HOT
FLUSHES: SPICY FOODS, COFFEE, TEA, ALCOHOL
5.USE COOLING TECHNIQUES: FANS, SHOWERS,
ICE CUBES
NURSING CARE:
1.ENCOURAGE WOMAN TO ENGAGE IN REGULAR
EXERCISE PROGRAM TO MAINTAIN MUSCLE TONE
2. EMPHASIZE ADEQUATE INTAKE OF CALCIUM
3. VIT D FOR BETTER CALCIUM ABSORPTION.
4.INSTRUCT ON PROPER USE OF WATER SOLUBLE
VAGINAL LUBRICANT FOR PAINFUL
INTERCOURSE.
5. INSTRUCT TO AVOID SMOKING & ALCOHOL
6. REGULAR PHYSICAL EXAMINATION.