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Block I: Reproduction & Sexuality > Clinical: Male Sexual Dysfunction > Flashcards

Clinical: Male Sexual Dysfunction Flashcards

1
Q

5 types of male sexual dysfunction

A
  • Erectile dysfunction (ED)
  • Hypogonadism
  • Ejaculatory disorders
  • Psychological issues
  • Penile deformity
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2
Q

Define hypogonadism as a male sexual dysfunction

A

Low libido, decreased energy

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3
Q

3 types of ejaculatory disorders

A
  • Premature
  • Delayed
  • Painful
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4
Q

2 erectogenic centers of the brain

A
  • Medial preoptic area
  • Hypothalamus paraventricular nucleus
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5
Q

Nervous pathway of erection

A
  1. Erectogenic centers
  2. Lumbosacral spinal cord
  3. Cavernoud nerves (S2-4)
  4. Smooth muscle relaxation in the copora cavernosa
    1. Arteries/arterioles
    2. Penile trabeculae
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6
Q

3 molecules involved in erection

A
  • Nitric oxide
  • cGMP
  • PDE (phosphodiesterase)
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7
Q

Role of nitric oxide in erection

A

Release of 2nd messenger in the arteries of the corpus cavernosa

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8
Q

cGMP role in erection

A

2nd messenger to cause a decrease in intracellular Ca2++ –> smooth muscle relaxation –> erection

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9
Q

Role of PDE in erection

A

Detumescence (cGMP hydrolysis)

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10
Q

Concurrent risk associated with ED

A

Cardiovascular disease

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11
Q

5 domains examined in the International Inventory of Erectile Function (IIEF)

A
  • Erectile function
  • Orgasmic function
  • Sexual desire
  • Intercourse satisfaction
  • Overall satisfaction
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12
Q

Describe how the SHIM score works

A

Score from 0 - 30 where higher = no ED and lower = increasing severity of ED

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13
Q

2 importants questions in the Androgen Deficiency in Aging Male (ADAM) questionnaire

A
  • Do you have a decrease in sex drive
  • Are your erections less strong
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14
Q

3 lab evaluations specific for ED

A

Testosterone
FSH
LH

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15
Q

3 other lab tests that can be used to evaluate male sexual dysfunction

A
  • Lipid profile
  • HbA1c
  • Fasting glucose
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16
Q

4 roles of testosterone in sexual function

A
  • Sexual desire and arousal
  • Frequency of sexual activity
  • Spontaneous erection
  • Ejaculation and orgasm
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17
Q

Why not give men with ED exogenous testosterone

A

Exogenous T will decrease:

  • Gonadotropins
  • Spermatogenesis

NOTE: Testosterone may be potential male contraceptive

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18
Q

6 conditions commonly associated with ED

A
  • Diabetes
  • Heart disease
  • Hypertension
  • Low HDL levels (dyslipidemia)
  • Smoking (in men with heart disease or hypertension)
  • Depression
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19
Q

METs of sex

A

3 - 5 (but big inter-individual variation)

20
Q

When is it safe to treat ED?

A

If patient has no symptoms for activities >5 METs

21
Q

3 PDE5 inhibitors

A
  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
22
Q

Compare the time of peak concentration for the 3 PDE5 inhibitors

A
  • Viagra = 1 hr
  • Cialis = 2 hours (slowest)
  • Levitra = 0.7 - 0.9 hours (shortest)

NOTE: Drug effects may be seen BEFORE peaks

23
Q

compare the half-lives of the 3 PDE5 inhibitors

A
  • Viagra = 4 hours
  • Cialis = 17.5 hours
  • Levitra = 4-5 hours
24
Q

Which PDE5 inhibitors can affect food absorption (slow it down)

A

Viagra and maybe Levitra

25
Q

4 common side effects that one can experience from ALL PDE5 inhibitors

A
  • Headache
  • Flushing
  • Dyspepsia
  • Nasal congestion
26
Q

Common side effect that one can experience with sildenafil and vardenafil only

A

Altered vision

27
Q

Common side effect of tadalafil only

A

Myalgia

28
Q

Absolute contraindication of PDE5 inhibitors

A

Concomitant usage of nitroglycerine in any form

29
Q

Why is nitroglycerine use contraindicated with PDE5 inhibitor use?

A

Any PDE5 inhibitor can potentiate the hypotensive effect of nitroglycerine and so you must not use them within the same 24 hour period (48 hours for tadalafil)

30
Q

4 alternatives to PDE5 inhibitors to help rectify ED

A
  • Vacuum pump
  • MUSE (Medicated Urethral System for Erection)
  • Intracavernous injection therapy
  • Penile prosthesis
31
Q

Pros of using vacuum pump

A

Cost-effective

Mechanical (no chemicals)

>80% effective

32
Q

Cons of vacuum pump

A

Should not use for >30 min

Complications of bruising and discoloration of glans (>50% dropout rate)

33
Q

Chemical used in MUSE

A

Prostaglandin E1

34
Q

Pro of MUSE

A

No need for a needle

35
Q

Con for MUSE

A

Only >50% effective

36
Q

4 substances involved in intracavernous injection therapy

A
  • Paperavine
  • Prostaglandin
  • Phentolamine
  • Moxisylyte
37
Q

4 complications of intracavernous injection therapy

A
  • Pain
  • Bleeding
  • Fibrosis
  • Priapism
38
Q

2 pros of penile prosthesis

A

~100% effective and able to achieve orgasm

39
Q

2 complications of penile prosthesis

A

Infection and mechanical failure

40
Q

When is sex therapy effective?

A

ED is due to psychological issues that are easily accessible

41
Q

When is sex therapy less effective

A

When ED is longstanding and is due to deep.complex psychological processes

42
Q

Most common sexual complaint

A

Premature ejaculation

43
Q

2 psychological treatments for premature ejaculation

A

Stop/start technique

Squeeze technique

44
Q

Medication to treat premature ejaculation

A

SSRIs

45
Q

Define retarded ejaculation

A

Delayed ejaculatoin, or no ejaculation

46
Q

Define primary retarded ejaculation

A

Cause = psychogenic

47
Q

Define secondary retarded ejaculation

A

Side effect of medication

Block I: Reproduction & Sexuality (23 decks)

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