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RDS Test 4 > B8.071 Male Sexual Dysfunction > Flashcards

B8.071 Male Sexual Dysfunction Flashcards

1
Q

classification of male sexual dysfunction

A
  1. libido
  2. erectile function
    - impotence
    - priapism
  3. disorders of ejaculation
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2
Q

libido

A

sexual drive or desire to engage in sexual activity

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3
Q

factors that affect libidom

A

T levels (most important)
chronic disease
depression
fatigue

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4
Q

evaluation of libido

A

AM T level (free T level in select cases)
general medical/physical evaluation
psychological evaulation

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5
Q

treatment of libido dysfunction

A

replace T if indicated and safe

treat other illness or depression

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6
Q

definition of erectile dysfunction

A

consistent or recurrent inability to attain or maintain penile erection sufficient for sexual satisfaction

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7
Q

prevalence of ED

A

30 mil men in US
52% of men between 40-70
-% correlates with decade (40% of men in 40s, 50% of men in 50s)

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8
Q

basic physiology of erection

A

more blood going into penis than coming out

  1. parasympathetics
    - cause vasodilation which results in erection
    - fibers come from the pelvic plexus and run along the side of the prostate
  2. sympathetics
    - responsible for ejaculation
    - cause detumescence by vasoconstriction
    - fibers from T12-L3 from hypogastric plexus run alongside of prostate
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9
Q

types of ED

A

arteriogenic/vasculogenic
neurologic
venous outflow
pscyhogenic

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10
Q

risk factors for ED

A 
HTN
surgery
diabetes
trauma
dyslipidemia
meds
depression
smoking
obesity
peripheral vascular disease
CVD
sedentary lifestyle
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11
Q

if a young-ish patient comes in with ED, what should you do in addition to treating the ED?

A

refer for a cardio workup

CVD issues commonly coexist

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12
Q

relationship between ED and diabetes

A 
20-85% of diabetics will suffer from ED
10-15 years earlier than general population
predictors of ED in diabetics
-peripheral neuropathy
-glycemic control
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13
Q

mechanism of ED in diabetics

A

small vessel disease affects inflow to penis

small vessel disease to the cavernosal nerves affects sympathetic input

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14
Q

classic signs of a diabetic who might have ED

A

peripheral neuropathy
diabetic retinopathy
renal insufficiency

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15
Q

number 1 cause of ED

A

arteriogenic/vasculogenic disease

hardening of arteries > can’t provide sufficient blood flow to penis

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16
Q

trauma and ED

A

may effect inflow or outflow

abnormal venous outflow termed “venous leak”

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17
Q

surgical causes of ED

A

radical prostatectomy
colon surgery
bladder surgery
may effect the cavernosal nerves which signal the blood vessels to dilate

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18
Q

pathophys of post prostatectomy ED

A

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

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19
Q

psychological components of ED

A

depression, stress, matrimonial discord

**rarely is ED completely psychogenic, over 90% have an underlying organic cause

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20
Q

illicit drugs that can cause ED

A

alcohol
marijuana
cocaine
cigs

21
Q

steps in diagnosis of ED

A
  1. H&P
    - rarely do anything other than this
    - usually just try a treatment and see if it helps
  2. US of penile arteries
    - penile arterial velocity >30 cm after injection with vasoactive agent
  3. xray tests of veins looking for venous leak
    - invasive
    - leak can be repaired by IT or surgical ligation
22
Q

lab eval of ED

A

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

23
Q

oral meds for ED

A 
PDE5 inhibitors
-sildenafil, vardenafil, tadalafil
testostozine, "the ropes", yohimbine
-never been proven to more
apomorphine (central acting)
-associated with nausea and vomiting
24
Q

sildenafil

A

first PDE5 on the market
25, 50, and 100 mg doses
4 hr half life

25
Q

side effects of sildenafil

A

headache
flushing
blue vision
dyspepsia

26
Q

contraindications for sildenafil

A

nitrates
unstable angina
recent MI or stroke (<2 wks)
retinitis pigmentosa

27
Q

tadalifil

A

most recent PDE5 inhibitor on the market
5, 10, 20 mg doses
17.5 hr half life

28
Q

side effects of tadalifil

A

headache
dyspepsia
myalgias

29
Q

contraindications for tadalifil

A 
a blockers (except tamsulosin)
nitrates
unstable angina
recent MI or stroke
reduce dose in pts with renal insufficiency (5 mg) and hepatic impairment (10 mg)
alcohol? maybe?
30
Q

vardenafil

A

2.5, 5, 10, 20 mg doses

4-5 hr half life

31
Q

side effects of vardenafil

A

headache
flushing
rhinitis

32
Q

contraindications for vardenafil

A 
drugs that prolong the QT interval (amiodarone, sotalol)
nitrates
unstable angina
recent MI or stroke
hepatic/renal impairment
33
Q

what is NAION

A

non-arteritic anterior ischemic optic neuropathy
can cause permanent loss of vision
-precaution for all PDE5 inhibitors
-only occurred in patients with multiple risk factors including DM, smoking, CVD, HTN, hyperlipidemia, low cup to disc ratio
may have several episodes of decreased vision before permanent loss occurs

34
Q

vacuum erection device

A

pros: safe, effective
cons: cumbersome, hinge effect, requires manual dexterity, cold penis

35
Q

muse

A

intraurethral alprostadil suppository
only effective in 30% of men
may cause vaginal irritation in female partner

36
Q

intracorporal injection therapy

A

very effective

pros: one of the most effective treatments, results in natural erection
cons: may cause burning or curvature, risk of priapism, expensive, requires manual dexterity

37
Q

penile prosthesis

A

infection risk
looks rough for a week
will lose some girth and length of the penis (set realistic expectations)
work well tho

38
Q

priapism

A

persistent erection which lasts for 4 or more hours

  • low flow
  • high flow
39
Q

characteristics of low flow priapism

A

painful
glans is soft
may “stutter”

40
Q

causes of low flow priapism

A 
incorrect use of intracavernosal agents
sickle cell disease
trazodone
TPN
neoplastic processes
41
Q

treatment of low flow priapism

A 
oral doesnt work
irrigation
-saline
-phenylepherine
shunts
42
Q

how to diagnose low flow priapsim

A

pO2 on blood gas
-super low O2
blood is thick, black, clotting

43
Q

characteristics of high flow priapism

A

non painful
not a full erection
glans full as well

44
Q

causes of high flow priapism

A

trauma resulting in AV fistula

45
Q

treatment of high flow priapism

A

embolization

46
Q

premature ejaculation

A 
ejaculation which occurs prior to coitus or before the patient would like
common in younger men
-treat with SSRI
may be a sign of ED
-treat with PDE5 inhibitor
47
Q

retrograde ejaculation

A

semen goes into the good ol bladder

  • diabetes
  • neurologic conditions
  • surgical procedures
  • meds
48
Q

anejaculation

A

disruption of sympathetic outflow

  • neuro conditions
  • after retroperitoneal surgery

RDS Test 4 (17 decks)

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