4. Erectile and ejaculatory conditions

Question 1

Causes of erectile dysfunction

Answer 1

• mind
• vasculature
• nerves
• endocrine disturbances
• drugs
• stress

Question 2

Erectile dysfunction treatment

Answer 2

PHOSPHODIESTERASE TYPE-5 INHIBITORS

• Sildenafil (1 hour before sex)
• Tadalafil (30 minutes before sex)
• Vardenafil (25-60 minutes before sex)
• Avanafil (30 minutes before sex)

PROSTAGLANDIN ANALOGUES

(HARMFUL TO PREGNANT WOMEN SO MUST BE USED WITH CONDOMS - Stimulate uterine contractions and cause msicarriages)

• Alprostadil administered to the penis vis urethra or topically

Question 3

Phosphodiesterase type-5 inhibitors mechanism of action

Answer 3

Increase blood flow to the penis by causing vasodilation

Question 4

Phosphodiesterase type-5 inhibitors counselling

Answer 4

Do not work without sexual stimulation.
Should be taken without food

Question 5

Phosphodiesterase type-5 inhibitors side effects, contraindications

Answer 5

side effects:
hypotension due to vasodilation:
flushing, headache, nasal congestion, palpitations and tachycardia

contra-indication:
REDUCED BLOOD PERFUSION: hypotension can lead to reduced blood perfusion to vital organs such as the heart or brain.
Must be avoided in recent MI, unstable agina or recent stroke

Interactions
Interacts with drugs that cause low blood pressure, that are vasodilators–>
- Nitrates, alpha-blockers (only given once stabilised), calcium-channel blockers, Nicorandil (A

Hypotensive side effects similar to nitrates as they cause vasodilation

Question 6

Premature ejaculation treatment

Answer 6

1st line: psychosexual counselling, education

2nd line (if life-long): SSRI’s such as dapoxetine, fluoxetine, paroxetine

Dapoxetine - licensed for when required