2.2.1 Treatment of Male Sexual Disorders

Question 1

What are some of the meds indicated in causing ED?

Answer 1

Anti-HTN meds, Psychological meds, Hormonal meds, H2 receptor blockers, Cold medicine preparations

Question 2

What is the #1 cause of erectile dysfunction?

Answer 2

Ateriogenic/vasculogenic

Question 3

What are three causes of psychological ED?

Answer 3

Depression, stress, matrimonial discord

Question 4

What are some of the associated conditions with retrograde ejaculation?

Answer 4

Diabetes, neurologic conditions, surgery, medications

Question 5

What is libido?

Answer 5

The sexual drive or desire to engage in sexual activity

Question 6

What is a common ejaculatory disorder in young men? How is it treated?

Answer 6

Premature ejaculation; Paxil (serotonin reuptake inhibitor)

Question 7

When diabetic patients typically affected by ED?

Answer 7

10-15 years earlier

Question 9

What is one of the terrible effects of PDE5 inhibitors?

Answer 9

NAION (non-arteritic anterior ischemic optic neuropathy)

43 cases to date

Question 10

What is the treatment of high flow priapism?

Answer 10

Embolization of high flow priapism

Question 11

How can libido be evaluated?

Answer 11

AM testosterone, general medical evaluation, psych evaluation

Question 12

What is the prevelance of ED?

Answer 12

30 million men in US

52% of men b/t 40 and 70

Question 13

How does a boner occur?

Answer 13

More blood going into the penis than going out

Question 14

What is the MOA of viagra (PDE5 inhibitor)?

Answer 14

Question 15

Where did priapism get its name?

Answer 15

Priapus - the god of fertility and nature

Question 16

What are some of the things that can affect libido?

Answer 16

Testosterone levels (most important), chronic dz, depression, fatigue

Question 17

What are the roles of the sympathetic and parasympthetic system in penis physiology?

Answer 17

Parasympathetic: vasodilation for erection (P for point)

Sympathetic: responsible for ejaculation (S for shoot)

Question 18

What are some of the risk factors for ED?

Answer 18

Question 19

What are the characteristics and causes of high flow priapism?

Answer 19

Question 20

What is the mechanism of ED in diabetic patients?

Answer 20

Small vessel dz affects inflow into penis

Small vessel dz to the cavernosal nerves affects sympathetic input

Question 21

What are some of the treatment options?

Answer 21

oral agents, constriction device/VED, intracavernosal injections

Question 22

What are some of the oral treatments for ED?

Answer 22

PDE5 inhibitors (viagra, levitra, cialis)

Testosterone, “The Ropes”, Yohimbine

Apomorphine

Question 23

What is ED? What is its other name?

Answer 23

The persistent inability to achieve or maintain an erection sufficient for intercourse

Impotence

Question 24

What are the 4 types of erectile dysfunction?

Answer 24

Arteriogenic/vasculogenic

Neurologic

Venous outflow

Psychogenic

Question 25

What drugs have been indicated in ED?

Answer 25

Alcohol, marijuana, cocaine, cigarettes

Question 26

What do you know about Levitra?

Answer 26

Question 27

What are some of the treatments for libido?

Answer 27

Replace testosterone (if safe and indicated) Treat illness or depression

Question 28

What are the characteristics and causes of low flow priapism?

Answer 28

Question 29

What is the most recent PDE5 inhibitor on the market?

Answer 29

Cialis

Question 30

Why is surgery a risk factor for ED?

Answer 30

May affect cavernosal nerves

Question 31

What is the pathophysiology of post prostatectomy ED?

Answer 31

Question 32

What are the different classifications of male sexual dysfunction?

Answer 32

Libido, Erectile Function (impotence, priapism), Disorders of Ejaculation

Question 33

What are the contraindications for viagra?

Answer 33

Patients on nitrates, w/ unstable angina, recent MI or stroke

Question 34

What is the Muse?

Answer 34

Question 35

How can the diagnosis of ED be made?

Answer 35

History and physical US of penile arteries X-ray tests of veins (venous leak) Testosterone levels

Question 36

What are some of the cellular mechanisms involved in erectile function?

Answer 36

Question 37

What % of patients with diabetes will suffer from ED across all ages?

Answer 37

20-85% (both T1DM/T2DM)

Question 38

What are some pros and cons of the penis vaccum (vaccum erection device)

Answer 38

Question 39

What is this? What causes it?

Answer 39

Priapism - persistent erection for more than 4 hours (low/high flow)

Question 40

What is Anejaculation?

Answer 40

disruption of sympathetic outflow (neurologic conditon or post retroperitoneal surgery)

Question 41

What are the three types of treatment for low flow priapism?

Answer 41

Oral - rarely works Irrigation Shunts (winters, Al-Ghorab, Quackels, Grayhack)

Question 42

What is one of the most effective treatments that leads to natural erections?

Answer 42

intracorporal injections