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2a Genitourinary > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

What nerve causes an erection?

A

Parasympathetic S2-4

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2
Q

What nerve causes ejaculation?

A

Sympathetic T11-L2

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3
Q

What position is the anatomical penis?

A

Erect (don’t get ventral and dorsal confused)

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4
Q

Which nerves are responsible for transmitting sensory information from the penis to the spinal cord? (somatic nerve)

A

Afferents dorsal penile nerves

(touch, pressure, temperature, pain)

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5
Q

Where does the pudendal nerve arise from?

A

The S2-4 nerve roots of the sacral plexus

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6
Q

What does the pudendal nerve innervate?

A

The perinuem, external genitalia, anus and associated pelvic floor muscles.

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7
Q

Sensory fibres within the pudendal nerve transmit information about touch, pressure, pain, and temperature from the ______ region to the spinal cord

A

perineal

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8
Q

The pudendal nerve also plays a crucial role in the motor control of the pelvic floor muscles, contributing to voluntary control over ____ and _____.

A

urination and defecation

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9
Q

What do the efferent pathway from Onuf’s nucleus innervate?

A

Ischiocavernosus muscle (contraction contributes to rigidity of erection)

Bulbocavernosus muscle (contraction assists in aiding ejaculation)

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10
Q

Which nerve do the efferent signals from Onuf’s nucleus travel through to reach the muscles they control?

A

Pudendal nerve (S2-4)

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11
Q

What are the regions within the hypothalamus that help control sexual response including erection?

A

Medial Preoptic Area (MPOA)
and
Paraventricular nucleus (PVN)

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12
Q

What is a useful acronym for the causes of erectile dysfunction?

A

IMPOTENCE

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13
Q

What does I in IMPOTENCE stand for?

A

Inflammatory:
prostatitis

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14
Q

What does M in IMPOTENCE stand for?

A

Mechanical:
Peyronie’s disease (fibrous scar tissue or plaques in penile tissue)

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15
Q

What does P in IMPOTENCE stand for?

A

Psychological:
Depression, anxiety, stress, relationship difficulties

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16
Q

What does O in IMPOTENCE stand for?

A

Occlusive (vascular):
Smoking, PVD, HTN, hyperlipidaemia, DM

17
Q

What does T in IMPOTENCE stand for?

A

Trauma:
pelvic fracture, SCI (spinal cord injury), penile fracture (rupture of tunica albuginea, fibrous covering surrounding corpora cavernosa, by sudden and forceful bending or snapping of erect penis)

18
Q

What does E in IMPOTENCE stand for?

A

Extra:
Pelvic surgery, prostatectomy, priapism, penile cancer

19
Q

What does N in IMPOTENCE stand for?

A

Neurogenic:
MS, stroke, spina bifida, peripheral neuropathy

20
Q

What does C in IMPOTENCE stand for?

A

Chemical:
antihypertensive, antidepressants, antipsychotics, anticonvulsants, statins, GNRH analogues, alcohol, cannabis, cocaine, heroin, diuretics

21
Q

What does E in IMPOTENCE stand for?

A

Endocrine:
DM, hypogonadism, hyperprolactinaemia, hypothyroidism, hyperthyroidism, hypocortisolism, hypercortisolism

22
Q

How do you assess for erectile dysfunction?

A

Cardiovascular
Abdomen
Neurological
Penis: Peyronie’s plaques, phimosis, deformities/lesions
Testes: presence, size and location
DRE: assess prostate

23
Q

What investigations do you do for erectile dysfunction?

A

Blood pressure
Essential bloods: fasting glucose and lipids, early morning testosterone

Other bloods
MRI

24
Q

What is first line treatment for erectile dysfunction?

A

PDE5 inhibitors: sildenafil (viagra), tadalafil
(1st line, oral meds. Contraindications = stroke, heart attack or arrhythmia in last 5 years, Tamsulosin don’t give viagra)

25
Q

What is second line treatment for erectile dysfunction?

A

Alprostadil (synthetic PGE1)
Intraurethral or injections.
Can be painful

26
Q

What is 3rd line treatment for erectile dysfunction?

A

Vacuum pumps with constriction band

27
Q

What is a surgical option for erectile dysfunction?

A

Penile Implant
(can get infected, bruising)

28
Q

What causes premature ejaculation?

A

Unknown
Perhaps to do with anxiety, reduced frequency of intercourse, obesity, prostatitis

2a Genitourinary (28 decks)

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