231/232 sexual dysfunction Flashcards
What neurotransmitters are responsible for male erection (both erectogenic and erectolytic)?
erectogenic: NO triggering cGMP release, prostaglandin E1, ACh, VIP, dopamine
erectolytic: adrenaline, GABA
What is the mechanism of PDE-5 inhibitors for treating ED?
PDE-5 normally degrades cGMP; inhibiting PDE-5 inhibitors prevent degradation and prolong erection
What medication is a contraindication for taking sildenafil?
nitrates (can lead to dangerous hypotension)
What are the three major types of ED?
psychogenic (performance anxiety, depression, etc)
organic (chronic diseases, medications, substances)
mixed
What physical exam findings can be associated with ED?
high BMI gynecomastia hypogonadism penile lesions scrotum problems prostate pathology
What are the therapies available for ED?
behavioral (weight loss, smoking cessation, exercise, therapy)
medical (ex. PDE-5 inhibitors)
surgical (penile prosthesis, revascularization)
What are the medical options for ED management?
phase I: oral medications (PDE-5 inhibitors)
phase II: intraurethral suppository, intracavernosal injections, vacuum erection device
also modification of medications for contributory medical factors (ex. diabetes, depression)
What medical comorbidities are associated with ED?
hypertension, diabetes, CV disease, hyperlipidemia, strokes, parkinson’s, MS, thyroid disease, hypogonadism, hyperprolactinemia
What is the role of neurotransmitters and endocrine hormones in a normal sexual response?
neurotransmitters are required for arousal/orgasm
hormones prime the brain to respond to NTs but are not necessary for sexual response
What are the components of a normal sexual response?
arousal –> libido –> intercourse –> orgasm
What are the excitatory and inhibitor controls of libido?
excitatory: dopamine (estrogen, testosterone, and NE play a role too)
inhibitory: serotonin (also prolactin and opioids)
What are the excitatory and inhibitory controls of arousal?
excitatory: dopamine, NE, NO, ACh (also estrogen and androgens)
inhibitory: serotonin, prolactin
What are the physical changes associated with arousal?
increased HR, BP, RR
decreased appetite
genital engorgement and responses (vaginal tenting/extension, lubrication)
What physical changes are associated with hetero intercourse?
pelvic floor muscles change, vagina lubrication (and elasticity)
increased blood supply
no central regulation or hormone regulation required
What neurotransmitter is involved in orgasm?
oxytocin - facilitates muscular contractions
