Erectile Dysfunction

Question 1

Definition of erectile dysfunction

Answer 1

Consistent or recurrent inability to maintain penile erection satisfactory for sexual performance

Question 2

Whos most likely to get ED

Answer 2

affects over 50% of men aged over 60

Question 3

Causes of ED - 7

Answer 3

• Vascular disease (atherosclerosis)
• Autonomic neuropathy
• medications (antihypertensives)
• psychogenic (anxiety/depression)
• Endocrine causes
• Pelvic surgery
• Anatomical abnormalities

Question 4

Associated Symptoms of ED - 3

Answer 4

Reduced sexual desire
Difficulty in ejaculation
Anxiety or depression related to sexual performance

Question 5

Differentials of ED - 3

Answer 5

• premature ejaculation
• hypogonadism
• Peyronies disease (bend in penis during erection which interferes with function)

Question 6

Investigations - 8 (6 blood tests)

Answer 6

Detailed history:
- if acute onset, most likely psychogenic cause
- if gradual onset, most likely to be vascular or neuropathy

Blood tests:
- FBC
- U and E
- TFTs
- Testosterone
- Lipids
- Prolactin

Question 7

Management of ED - 5

Answer 7

• Psychosexual therapy
• Oral phosphodiesterase inhibitors e.g. Sildenafil
• Vacuum erection devices to draw blood into the penis
• Intra-cavernosal injections
• Penile prostheses when all else fails