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Aula Disfunções Sexuais - Alunos do quarto ano Faculdade Med USP

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curso graducao faculdade de medicina da USP - Aula Disfunções Sexuais - Alunos do quarto ano Faculdade Med USP

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Aula Disfunções Sexuais - Alunos do quarto ano Faculdade Med USP

  1. 1. Conrado Alvarenga Grupo de Medicina Sexual HCFMUSP Disfunções Sexuais Masculinas
  2. 2. Parafilias Padrão comportamento sexual no qual a fonte predominante do prazer não esta na penetração Sadismo, Masoquismo, Exibicionismo, Voyeurismo e Fetichismo Pedofilia, Necrofilia, Agorofilia, Asfixofilia, Urofilia, Zoofilia, Sarilofilia, Pregnofilia.........
  3. 3. O HOJE • O médico que cuida de sexualidade precisa entender o hoje • O MACRO na sexualidade • Rapport
  4. 4. Tinder -2013 22 milhões de matchs / dia Mundo 220 views, 70 mensagens e 5 telefonemas – destes 30% com sexo final 4 views, 6 mensagens e 1 ou 2 telefonemas – 50% com sexo final
  5. 5. • Menage Masculino e Feminino • Crescimento de 180% nos clubes de Swing nos últimos 3 anos • Sexo-kids / Exposição precoce • Muitas outras mudanças atuais
  6. 6. Transar esta mais fácil? 2014 • Geração atual entre 13 e 30 anos • Não viveu o HIV- década 80/90 • Crescimento 50% novos casos HIV • Pesquisas de cura hepatite C, avanço contra HPV, HIV como doença crônica....... • Doenças como sífilis cavidade oral, cancro mole...... • Pílula do HIV pré sexo • Diminuição do Medo??????
  7. 7. • Nessas discussões, as opiniões dividem-se entre aqueles que veem esta configuracão como uma̧ quebra de barreiras físicas e culturais e aqueles que consideram que estamos diante de uma “superficializacão” das relacões humanas e da̧ ̧ relacão com o mundo.̧
  8. 8. PREP
  9. 9. Healthy people at risk for HIV are advised to take daily antiretroviral pills that cut the odds of infection by more than 90 percent, according to U.S. health officials. 2016 Brasil $$$$$ ????
  10. 10. 2014
  11. 11. Sexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern.
  12. 12. Definição A disfunção sexual masculina é uma subdivisão da Urologia que estuda as disfunções sexuais da ereção, do orgasmo e da ejaculação
  13. 13. Definição A disfunção erétil (DE) é definida como a incapacidade persistente ou recorrente do homem obter e ou manter ereção suficiente para a atividade sexual
  14. 14. Epidemiologia
  15. 15. Fisiologia: Ciclo Sexual no Homem
  16. 16. Fisiologia: Ciclo Sexual no Homem Os 5 Sentidos
  17. 17. Fisiologia: Ciclo Sexual no Homem
  18. 18. Fisiologia: Ciclo Sexual no HomemEstímulo Sexual Endotélio NO GC (Guanilato Ciclase) GTP (Guanosina Trifosfato) INATIVA cGMP (Guanosina Monofostato Ciclica) ATIVA Relaxamento / Enchimento / Ereção I-5PDE
  19. 19. Classificação
  20. 20. Etiologia Orgânica
  21. 21. Etiologia Psicogênica Modernamente entende-se que a disfunção sexual masculina está associada à desordens psicológicas: Problemas emocionais: Ansiedade Estresse = Desejo sexual Depressão Disfunção Erétil Ejaculação Precoce
  22. 22. Diagnóstico I. Avaliação Médica 1. HPMA + Exame Físico 2. História Psicossexual 3. Questionário IIEF-5 II. Opcionais 1. IIC 2. Eco-doppler
  23. 23. Tratamento A – Medicamentoso Oral IIC Reposição Androgênica B – Cirúrgico – Próteses C – Bomba Vácuo
  24. 24. Terapêutica - Clínica ou Cirúrgica?
  25. 25. Terapêutica Oral - 1ª linha CUIDADO EM JOVENS
  26. 26. Injeção intra cavernosa ALPROSTADIL 20mcg PAPAVERINA 20mg FENTOLAMINA 5mg
  27. 27. Injeção intra cavernosa
  28. 28. Tratamento cirúrgico Prótese Peniana Maleável – SUS
  29. 29. Tratamento cirúrgico Prótese Peniana Inflável $$$$$$$$$
  30. 30. Cirurgias de Aumento Peniano
  31. 31. Faloplastia
  32. 32. Cirurgias de Aumento Peniano • SBU 2012 Não recomenda cirurgias de aumento peniano, uso de anestésicos locais para controle da ejaculação precoce, injeções de produtos no pênis para aumentar o diâmetro do órgão, dentre outras medidas que costumam atrair alguns homens preocupados em tonificar o desempenho sexual.
  33. 33. Tração Peniana
  34. 34. Bomba Vácuo
  35. 35. Desordens do Orgasmo e da Ejaculação Anorgasmia Ejaculação Precoce/ Ejaculação Retardada Anaejaculação Ejaculação Retrógrada Disorgasmia
  36. 36. Desordens do Orgasmo e da Ejaculação
  37. 37. Desordens do Orgasmo e da Ejaculação
  38. 38. Desordens do Orgasmo e da Ejaculação • Tratamento • Primaria versus secundaria • Love Games • Terapia sexual • Paroxetina – Serotonina
  39. 39. Desordens do Orgasmo e da Ejaculação
  40. 40. Desordens do Orgasmo e da Ejaculação
  41. 41. Desordens do Orgasmo e da Ejaculação

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