ED 3.2 Flashcards
What is definition for ED?
Persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance
> no universal criteria
> occasional episodes ok
> recurrence/persistence (>3 months) = reasonable guide
What is ED associated with?
Cardiovascular disease and diabetes
> “Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors”
What is the mechanism of an erection?
- Sexual arousal
- Release of NO from neurone synapses in corpus carvenosum of penis
- Accumulation of cyclic guanosine monophosphate (cGMP)
- Smooth muscle relaxation
- Inflow of blood to the corpus carvenosum
- Erection
What are some vascular causes of ED?
- Atherosclerosis, PVD, MI
- Hypertension, dyslipidaemia
- Vascular injury
- Blood vessel and nerve trauma
What systemic diseases can cause ED?
- Respiratory –> COPD and sleep apnoea
- Endocrine –> hyper/hypothyroidism, hypogonadism, DM
- Renal/liver failure
- Cancer
What neurological conditions causes ED?
- Epilepsy, stroke
- MS, Guillain-Barre syndrome
- Alzheimers disease
What psychiatric conditions cause ED?
Depression
Performance anxiety
PTSD
> surgery, medications, drug/alcohol alll can contribute also
What are some risk factors for ED? Include a comprehensive list of medications that do also please.
Increasing age
Some clinical conditions
Smoking
Medications
- Antihypertensives
- Antidepressants (SSRIs)
- Antipsychotics (olanzapine and risperidone)
- H2As
- 5-alpha-reductase inhibitors = reduce testosterone
- Gemfibrozil
- Methadone
- Hormones
- Cytotoxic agents
- Immunomodulators
- Anticholinergic agents
- Opioids
- Recreational drugs
What need to assess and test patient for before commencing pharmacotherapy? What is sufficient cardiac fitness for sexual activity?
Sufficient cardiac fitness for sexual activity = climb 20 stairs in 15 seconds
rest of the answer see attached image
What is an example of a questionaire to assess ED? What score is used?
5-item IIEF5 score
<22: ED
17-21: Mild ED
8-16: Moderate ED (mild to moderate 12-16)
<8: Severe ED
How is ejaculation mediated? What are the 2 phases?
Mediated by autonomous nervous system
2 phases
- Emission
- Expulsion
What is the pathogenesis of premature ejacualtion?
- Psychorelational
- Neurobiological
- Urological
- Hormonal
- Andrological
How is premature ejaculation defined?
Persistent or recurrent ejaculation before, during or shortly after penetration
> intravginal ejucalatory time of <2 minutes
2 types of premature ejaculation?
Primary: lifelong (from beginning of sexual experience); never had control over ejaculation
Secondary: acquired, i.e. secondary to other factors (situitational ED)
What is anejaculation and retrograde ejaculation caused by?
Interruption of neural pathways of ejaculation
> autonomic neuropathies (especially in long-term diabetes)
What is anejaculation?
Complete absence of ejaculation
Normal orgasmic sensation
Treatment
> counselling
> sperm retrieval techniques
What is retrograde ejaculation? Tx?
Semen passes backwards into the bladder
Little or no sperm is discharged
May be secondary to prostate surgery, DM
Normal or decreased orgasmic sensation
Treatment
- Several days before semen collection or ovulation: imipramine or pseudoephedrine = helps keep bladder neck closed
