Erectile disorder

Question 1

Define ED

Answer 1

ICD: Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

DSM-5: Marked difficulty in obtaining/maintaining an erection during sexual activity. There is a marked decrease in erectile rigidity.

Question 2

Epidemiology

Answer 2

52% of people aged 40-70 years are affected

Question 3

RFs

Answer 3

V similar to CVS disease:

• lack of exercise
• obesity
• smoking
• hypercholesterolaemia
• hypertension
• DM
• metabolic syndrome

Question 4

Causes

Answer 4

Chronic medical conditions:
- CVD, DM, neurological disease

Hormonal disorders:
- androgen deficiency, high prolactin

Iatrogenic:
- post prostate surgery, anti hypertensives, SSRIs

Age related changes

Ineffective sexual stimuli

Pain

Veno-occlusive disorder

Mental health conditions:
- depression, anxiety, substance misuse

Performance anxiety, life events, previous negative experiences, unhelpful use of pornography

Couple script problems

Relationship problems

Education

Cultural/religious matters

Question 5

Ix

Answer 5

Fasting glucose/HbA1c and lipid profile (diabetes)

Testosterone level

PSA

Doppler blood flow

Question 6

Tx

Answer 6

treat modifiable RFS:

• stop smoking
• more exercise
• drink less alcohol etx

Question 7

Medication tx

Answer 7

oral sildenafil (viagra), avanafil (spedra), tadalafil (cialis), vardenafil (levitra)

injectable: alprostadil
intraurthral: alprostadil pellet or cream

need to follow up to ensure tx is effective and to educate

Question 8

Patient education when giving medication

Answer 8

Sexual stimulation is required, work best if on an empty stomach, need to wait 45-60 minutes

Question 9

Non medical treatment

Answer 9

• vacuum device
• penile/scrotal rings
• new stimulating routines e.g. enhancing lubricants, vibrators
• Kegel exercises

Question 10

How to reduce performance anxiety

Answer 10

Psychosexual therapy