B8.071 Male Sexual Dysfunction Flashcards
classification of male sexual dysfunction
- libido
- erectile function
- impotence
- priapism - disorders of ejaculation
libido
sexual drive or desire to engage in sexual activity
factors that affect libidom
T levels (most important)
chronic disease
depression
fatigue
evaluation of libido
AM T level (free T level in select cases)
general medical/physical evaluation
psychological evaulation
treatment of libido dysfunction
replace T if indicated and safe
treat other illness or depression
definition of erectile dysfunction
consistent or recurrent inability to attain or maintain penile erection sufficient for sexual satisfaction
prevalence of ED
30 mil men in US
52% of men between 40-70
-% correlates with decade (40% of men in 40s, 50% of men in 50s)
basic physiology of erection
more blood going into penis than coming out
- parasympathetics
- cause vasodilation which results in erection
- fibers come from the pelvic plexus and run along the side of the prostate - sympathetics
- responsible for ejaculation
- cause detumescence by vasoconstriction
- fibers from T12-L3 from hypogastric plexus run alongside of prostate
types of ED
arteriogenic/vasculogenic
neurologic
venous outflow
pscyhogenic
risk factors for ED
HTN surgery diabetes trauma dyslipidemia meds depression smoking obesity peripheral vascular disease CVD sedentary lifestyle
if a young-ish patient comes in with ED, what should you do in addition to treating the ED?
refer for a cardio workup
CVD issues commonly coexist
relationship between ED and diabetes
20-85% of diabetics will suffer from ED 10-15 years earlier than general population predictors of ED in diabetics -peripheral neuropathy -glycemic control
mechanism of ED in diabetics
small vessel disease affects inflow to penis
small vessel disease to the cavernosal nerves affects sympathetic input
classic signs of a diabetic who might have ED
peripheral neuropathy
diabetic retinopathy
renal insufficiency
number 1 cause of ED
arteriogenic/vasculogenic disease
hardening of arteries > can’t provide sufficient blood flow to penis
trauma and ED
may effect inflow or outflow
abnormal venous outflow termed “venous leak”
surgical causes of ED
radical prostatectomy
colon surgery
bladder surgery
may effect the cavernosal nerves which signal the blood vessels to dilate
pathophys of post prostatectomy ED
neurological
-endothelial and smooth muscle changes result from loss of innervation
-neural factors may play a role
arterial insufficiency
-preservation of the pudendals or accessory obturators
veno-occlusive dysfunction
-venous leak results
anatomical/structural changes
hormonal
-number of pts appear to be hypogonadal after
psychogenic
psychological components of ED
depression, stress, matrimonial discord
**rarely is ED completely psychogenic, over 90% have an underlying organic cause
illicit drugs that can cause ED
alcohol
marijuana
cocaine
cigs
steps in diagnosis of ED
- H&P
- rarely do anything other than this
- usually just try a treatment and see if it helps - US of penile arteries
- penile arterial velocity >30 cm after injection with vasoactive agent - xray tests of veins looking for venous leak
- invasive
- leak can be repaired by IT or surgical ligation
lab eval of ED
T may be associated with decreased libido
-normally don’t check this unless pt complains of low libido, most men with low T maintain erectile function
270-900 is normal
oral meds for ED
PDE5 inhibitors -sildenafil, vardenafil, tadalafil testostozine, "the ropes", yohimbine -never been proven to more apomorphine (central acting) -associated with nausea and vomiting
sildenafil
first PDE5 on the market
25, 50, and 100 mg doses
4 hr half life
