Erectile Dysfunction Flashcards
-add surgical cards later
Normal male erection is a neurovascular event relying on:
(a) An intact autonomic and somatic nerve supply to the ___,
(b) Arterial blood flow supplied by the paired _____arteries,
(c) Smooth and striated musculature of the corpora cavernosa and pelvic floor
a) penis
b) cavernosal
Erection is caused and maintained by:
(a) Increase in_____,
(b) Active relaxation of the smooth muscle within the sinusoids of the corpora cavernosa,
(c) An increase in ______.
a) arterial flow
b) venous resistance
What is a key neurotransmitter that initiates and sustains erections?
Nitric oxide
What is the consistent inability to attain or maintain a sufficiently
rigid penile erection for sexual performance?
Erectile dysfunction (ED)
Organic erectile dysfunction may be an early sign of ______ disease and requires evaluation.
cardiovascular disease
Patient history for ED
Loss of libido may indicate a ______ deficiency
androgen
True/False
Patient history for ED
Loss of erections may result from arterial, venous, neurogenic, hormonal, or psychogenic causes.
True
Patient history for ED
The most common cause of erectile dysfunction is……
a decrease in arterial flow resultant from progressive vascular disease
Erectile dysfunction may be an early manifestation of endothelial dysfunction, which precedes more severe _______ disease.
atherosclerotic cardiovascular
What medications may be associated with ED?
antihypertensive
antidepressant
opioid agents
What is a fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity?
Peyronie disease
_______ is the loss of seminal emission
Anejaculation
What may result from
1) Androgen deficiency by decreasing prostate and seminal vesicle secretions,
2) Sympathetic denervation as a result of spinal cord injury, diabetes mellitus or
pelvic or retroperitoneal surgery or radiation
Anejaculation
Laboratory test to consider for ED:
(1) Lipid profile -Evaluating for dyslipidemia
(2) Glucose- Evaluating for diabetes mellitus
(3) Testosterone - If abnormalities of T are found (hypogonadism)
- – Free testosterone (must be drawn between 8-10 AM to be accurate)
- –Luteinizing hormone
When should Free-T be drawn to be accurate?
8-10 am
Treatment for ED
- Lifestyle modifications and reduction of Cardio risk factors
- Men with psychogenic component benefit from sexual health therapy or counseling
- Hormonal replacement offered to men with hypogonadism
- —Managed by UROLOGY
- Oral agents
- –Sidenafil (Viagra) 25-100mg PO, 1 hour prior to sexual activity
- –Vardenadil (Levitra) 5-20mg PO, 1 hour prior to sexual activity
- –Tadalafil (Cialis) 2.5mg PO daily or 10mg PO at least 30 minutes prior to sexual activity
- –Avanafil (Stendra) 50-200mg PO, 15 minutes prior to sexual activity
- Other treatments:
(a) Urethral injectable - Prostaglandin E2
(b) Vacuum Erection device
(c) Penile prosthetic surgery
(d) Vascular reconstruction
Refer to urology if……..
(a) Priapism (MEDEVAC)
(b) Initial oral therapy initiation
(c) Inadequate response to oral medications,
(d) Unable to tolerate side effects
(e) Peyronie disease or other penile deformity
(f) History of pelvic or perineal trauma, surgery, or radiation.
When would you refer to Urology?
(a) Priapism (MEDEVAC)
(b) Initial oral therapy initiation
(c) Inadequate response to oral medications,
(d) Unable to tolerate side effects
(e) Peyronie disease or other penile deformity
(f) History of pelvic or perineal trauma, surgery, or radiation.
Complication for ED
Priapism (MEDEVAC)
Definition of what?
Occurrence of penile erection lasting longer than 4 hours
Priapism
Initial treatment for priapism is what?
- aspiration of blood from the penis
- injection of sympathomimetic drugs (epinephrine or phenylephrine)
Lifestyle factors to consider for ED
Note severity, intermittency and timing
1) Sexual orientation
2) Quality of relationship with partner
3) Alcohol
4) Tobacco
5) Marijuana
6) Other recreational drugs
7) Use of pornography to maintain arousal
Medical history factors to consider for ED
Note severity, intermittency and timing
1) Medication review
2) Dyslipidemia
3) Hypertension
4) Depression
5) Neurologic disease
6) Pelvic trauma, surgery or irradiation.
7) Prostate cancer
8) Peyronie disease
Physical Exam factors to consider for ED
Note severity, intermittency and timing
a) Vital signs (looking for HTN or other signs of cardiovascular disease)
(b) Body habitus (obesity)
(c) Secondary sexual characteristics
(d) Cardiovascular exam
(e) Neurologic exam
(f) Genitalia exam
- –Stretched length of penis
- – Presence of Peyronie disease
- –Abnormalities in size or consistency of testicle
When conducting a Genitalia exam for your suspected ED pt what are you going to note?
- –Stretched length of penis
- – Presence of Peyronie disease
- –Abnormalities in size or consistency of testicle
ED should be distinguished from problems with….
(a) Deformity
(b) Libido
(c) Orgasm
(d) Ejaculation
