Erectile and ejaculatory conditions

Question 1

Erectile dysfunction can

Answer 1

have physical or psychological causes. It can also be a side-effect of some drugs such as antihypertensives, antidepressants, antipsychotics, cytotoxic + recreational drugs (inc. alcohol).

Question 2

Risk factors include

Answer 2

sedentary lifestyle, smoking, obesity, hypercholesterolaemia + metabolic syndrome

Question 3

Lifestyle changes include

Answer 3

• regular exercise, reduction in BMI, smoking cessation and reduced alcohol consumption)

Question 4

1st line drug treatment

Answer 4

• An oral phosphodiesterase-5 inhibitor is the 1st line drug treatment. These drugs act by increasing blood flow to the penis, but they do not initiate an erection (sexual stimulation is required).

Question 5

are short-acting drugs suitable for occasional use as required

Answer 5

• Avanafil, Sildenafil and Vardenafil

Question 6

longer-acting. It can be use as required

Answer 6

• Tadalafil is longer-acting. It can be use as required, but also be taken at a regular lower daily dose for spontaneous (rather than scheduled) sexual activity.

Question 7

2nd line under medical supervision.

Answer 7

• Alprostadil (alternative route of administration) is used 2nd line under medical supervision.

Question 8

MHRA • Alprostadil

Answer 8

Priapism associated with Alprostadil
- Patients should seek medical help If a prolonged erection lasting >4 hours occurs. Application of an ice-pack to the upper-inner thigh (alternating between left and right thighs every 2 minutes) for 10 minutes may be of benefit in reflex opening of the venous valves.

Question 9

When to refer priapism to A+E

Answer 9

If priapism lasts more than 6 hours… patient should be admitted to A+E.

Question 10

Premature ejaculation

Answer 10

Premature ejaculation is a common male sexual disorder. For patients with life-long premature ejaculation, drug treatment is the recommended approach.

Question 11

Premature ejaculation treatment.

Answer 11

• Dapoxetine (short acting SSRI) is licensed to be used when required for this condition (not continuous daily use)
• Ejaculation delay may start a few days after the start of treatment, but it is more evident after 1 to 2 weeks, since receptor desensitisation takes time to occur.