Aug31 M1-Erectile dysfunction Flashcards
5 forms of sexual dysfunction
- erectile dysfunction (ED)
- hypogonadism (andropause = low testo)
- ejaculatory disorders (premature, delayed, painful)
- psychosocial issues
- Peyronie’s disease (anatomical deformity, bending bc of scarring in tunica albugenia)
most important nerve for erection
cavernous nerves (S2 to S4)
main thing for erection to occur
SM relaxation in the corpora cavernosa (2 of these. note spongiosum with urethra). vessels are in cavernous bodies and blood goes in sinusoid levels.
(important) main ntr for erection
nitric oxide
cells releasing NO
- NANC nerves (non adrenergic non cholinergic)
- endothelial cells
- NO goes to SM cells
how NO causes SM relaxation around corpora cavernosa
- 2nd messenger (cGMP) is increased
- this decreases IC Ca
- SM relaxes
how to get rid of erection (molecularly)
phosphodiesterase enzyme hydrolyzes cGMP, IC Ca back up, SM contracts
approach to ED management
- Hx and PE
- assess CV risk
- if good CV status, start meds
why assess CV risk in ED
same risk factors for ED and CVD
5 forms on sexual dysfunction
- ED
- psychosocial
- andropause
- ejaculatory disorders (like premature)
- Peyronie
how to qt ED
questionnaires give scores
right name for andropause (hypogonadism), can still have good erection
androgen deficiency in aging male (ADAM)
lab tests specific for ED
- testo (bc low testo can cause ED, so this is the link between ADAM and ED)
- FSH
- LH
- HbA1c (poorly controlled diabetes is assoc with ats and bad erectile fct)
link between hypogonadism and ED
two diff things but the low testo can cause ED
symptoms, signs of low testo
- less desire and arousal
- less frequency of sexual activity
- lower semen level
- ED
why not give exogenous testo to cure ED
negatively feedbacks on pit and less FSH and LH are produced so less sperm prod and less testo
risk factors for ED (same as CVD)
- lifestyle
- smoking
- BMI
- stress
- lipids
- htn
- glycemic control
- FHx
- Age
- Gender
(imp?) 2 conditions most assoc with ED
- heart disease
2. diabetes
(imp) categories of cardiac risk + approach for if can have sex or not + if can get ED meds
- low = stable angina, controlled htn, no sx
- interm = mild SOB or angina, mild sx
- high = unstable angina, uncontrolled htn
- can have sex + can get ED meds if no symptoms in activities of MET>5 (metabolic index)*
3 ED meds
- sildenafil (viagra)
- tadalafil (cialis)
- vardenafil (levitra)
ED meds do what
inhibitors of PDE5 enzyme which hydrolyzes cGMP in SM
(imp) most imp contraindication for ED meds
nitroglycerine (can’t take if on nitro) (bc nitro lowers BP and PDE5i will lower it even more)
diff between ED meds
tadalafil (cialis) much higher half life than sildenafil (viagra) but therefore sildenafil peaks (effect) before
how to mix nitro and ED meds
- can take nitro 24 hrs after sildenafil and vardenafil
- can take nitro 48 hrs after tadalafil
other ways of reducing ED if meds don’t work (PDE5i)
- control modifiable risk factors
- stop smoking
- exercise
- control DM, lipids, CV status
- control depression
- control weight - patient educ on best time to take the drugs
- optimize dose
- switch med (placebo)
