Erectile Dysfunction Flashcards
What is erectile dysfunction?
Constant inability to attain or maintain penile erections of sufficient quality to allow satisfactory sexual intercourse
What are the organic causes?
Vascular/arterial cause
Neurogenic (Parkinson’s, Epilepsy, MS, stroke)
Anatomical (issues with structure)
Secondary to surgery
What are the other causes?
Psychogenic
Drugs + substances
Riding bikes
How do you investigate?
Serum lipids
Fasting glucose
Hormonal testing
Ultrasound
Nocturnal penile tumescence
Vascular studies of penis
Why investigate nocturnal penile tumescence?
If happening when asleep = NOT organic problem = psychological problem
Why refer to urology?
For young men who always had difficulty in obtaining or maintaining an erection
Why refer to endocrinology?
For men who have hypogonadism (abnormal testosterone)
Why refer to cardiology?
For men who have severe/unstable CVD that would make sex unsafe
Why refer to mental health services?
For men with a psychogenic underlying cause
How do you manage?
Lifestyle
Weight loss
Regular exercise
Healthy diet
Cessation of smoking
Moderate alcohol consumption
What are the different treatment options?
Medications = tablets/injections
Implants
Vacuum devices
Prosthesis surgery
What is the MoA?
Stimulation to penis
Sildenafil inhibits PDE
Alprostadil stimulate adenylate cyclase
= vasodilation of penile arteries
What is 2nd line treatment?
Prostaglandins injection at time of sex
= who fail with 1st line
How does prostaglandins work?
Cause vasodilation + smooth muscle relaxation
What are the PDE5s?
Sildenafil, vardenafil, avanafil (short acting)
Tadalafil (long acting)
