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)
