A/23. Male sexual dysfunctions Flashcards
List Male sexual dysfunctions
- PREMATURE EJACULATION (PE)
- ERECTILE DYSFUNCTION (ED)
- LATE-ONSET HYPOGONADISM (LOH)/testosterone deficiency syndrome (TDS)
PREMATURE EJACULATION (PE). Define
referred to as rapid or early ejaculation, is defined according to three essential criteria:
* Brief ejaculatory latency (< 1 min)
* Loss of control
* Psychological distress in the patient and/or partner
criteria that define Premature ejaculation
defined according to three essential criteria:
* Brief ejaculatory latency (< 1 min)
* Loss of control
* Psychological distress in the patient and/or partner
PREMATURE EJACULATION (PE) Treatment
- Pharmacotherapy:
*SSRIs are considered 1st line (paroxetine, citalopram, dapoxetine) -short half-life :taken ‘on demand’ 1-3 hours before intercourse)
*TCAs are considered 2nd (SE limits their use): Clomipramine
*Tramadol is considered 3rd line
*Topical lidocaine or other anesthetic are also an option
*PDE-5 inhibitors are used if PE occurs together with ED
Psychotherapy, sex therapy
1st line treatment of Premature ejaculation
*SSRIs are considered 1st line (paroxetine, citalopram, dapoxetine) -short half-life :taken ‘on demand’ 1-3 hours before intercourse)
2nd line treatment of premature ejaculation
*TCAs are considered 2nd (SE limits their use): Clomipramine
3rd line treatment of premature ejaculation
Tramadol is considered 3rd line
which drug used if Premature ejaculation occurs together with Erectile dysfunction
*PDE-5 inhibitors are used if PE occurs together with ED
ERECTILE DYSFUNCTION (ED) definition
..is defined as persistent or recurrent inability to acquire or maintain an erection of sufficient rigidity or
duration for sexual intercourse
ERECTILE DYSFUNCTION (ED) etiologies
(‘PENIS’ mnemonic)
* Psychological (stress, performance anxiety, depression); nighttime erection is normal
* Endocrine (decreased testesterone)
* Neurogenic (post-operative, spinal cord injury, stroke, MS)
* Insufficient blood flow (atherosclerosis, HTN, CHF, diabetes, smoking, dyslipidemia)
* Substance (alcohol, antidepressants, antihypertensive, antipsychotics)
what is erectile dysfunction strongly associated with
increased risk of cardiovascular morbidity and mortality;
among patients 40-50 years old with ED,
CV risk increases by x48.
ERECTILE DYSFUNCTION (ED) diagnostic criteria
- Difficulty/failure to develop erection in > 75% of all sexual intercourses
- Lasts > 6 months
- Causes clinically significant distress
- Not due to another mental disorder, severe relationship distress, substance abuse, or an organic disorder
No specific test for diagnosis.
Consider psychological stressors
screen for organic CV diseases
check blood glucose and testosterone levels
duplex US to evaluate penile blood flow
diagnosis of erectile dysfunction
No specific test for diagnosis.
Consider psychological stressors
screen for organic CV diseases
check blood glucose and testosterone levels
duplex US to evaluate penile blood flow
Treatment of erectile dysfunction
- PDE-5 inhibitors (sildenafil, tadalafil, vardenafil): considered the only 1st line therapy
- Intra-cavernous injection therapy (PGE1 analogue = alprostadil): considered 2nd line if PDE-5 inhibitors are ineffective
- Testosterone replacement : if patient’s serum testosterone is low (< 8 nM)
- Psychotherapy: counseling, sensate focus exercises for performance anxiety, group psychotherapy
- Vacuum constriction device (VCD)
- Surgical: implantation of penile prosthesis (only when all other means have failed)
1st line treatment of erectile dysfunction
what to use if it fails?
PDE-5 inhibitors (sildenafil, tadalafil, vardenafil): considered the only 1st line therapy
- Intra-cavernous injection therapy (PGE1 analogue = alprostadil): considered 2nd line if PDE-5 inhibitors are ineffective
PDE-5 inhibitors are Contraindicated in
taking nitrates due to profound hypotension
SE of PDE-5 Inhibitors
May cause orthostatic hypotension in patients taking alpha-blockers (for BPH)
and
should therefore be taken >4 hours apart
Indication of Testosterone replacement in erectile dysfunction
if patient’s serum testosterone is low (< 8 nM)
2nd line treatment of erectile dysfunction
Intra-cavernous injection therapy (PGE1 analogue = alprostadil): considered 2nd line if PDE-5 inhibitors are ineffective
Vacuum constriction device (VCD) what is it
hollow cylinder that is placed onto the penis, with penis ring
(outflow obstruction of the existing erection).
What is surgical treatment of erectile dysfunction?
Surgical: implantation of penile prosthesis (only when all other means have failed)
LATE-ONSET HYPOGONADISM (LOH) other name for it
testosterone deficiency syndrome (TDS),
LATE-ONSET HYPOGONADISM (LOH)/testosterone deficiency syndrome (TDS) define
is a clinically and biochemically defined disease of
older men.
LATE-ONSET HYPOGONADISM (LOH) characterized by
Characterized by
* serum testosterone level below the reference parameters of younger healthy men, (<10nM)
* and by symptoms of testosterone deficiency, manifested by pronounced disturbances of the quality of life and
harmful effects on multiple organ systems.
LATE-ONSET HYPOGONADISM (LOH) is a consequence of
of the aging process,
deterioration of hypothalamic-pituitary function, and Leydig cell
function in the testes.
LATE-ONSET HYPOGONADISM (LOH) treatment
Testosterone replacement therapy (TRT) may present several benefits regarding:
* body composition
* metabolic control
* and psychological and sexual parameters.
Testosterone replacement therapy (TRT) side effects
- accelerated CV morbidity and mortality
- erythrocytosis
- prostate pathology
Testosterone replacement therapy (TRT) Contraindications
include
* prostate cancer
* breast cancer
* planned pregnancy
