Erectile Dysfunction

Question 1

What are the risk factors for erectile dysfunction?

Answer 1

• Age
• DM
• HTN
• Obesity
• Dyslipidemia
• Smoking
• Low testosterone
• Cardiovascular disease
• Drugs:
  
  • SSRIs
  • Spironolactone
  • Thiazide diuretics
  • Cimetidine

Question 2

What are the causes of erectile dysfunction?

Answer 2

Psychogenic:
- Usually sudden
- Will usually still have nocturnal erections

Organic:
- Medications (especially antihypertensives)
- Arterial insufficiency
- DM
- Hypo/hyperthyroidism
- Prostate cancer
- Lifestyle:
- Drug abuse
- Alcoholism
- Smoking

Question 3

How should erectile dysfunction be evaluated?

Answer 3

Include in medical evaluation:
- Ask about any other medical problems
- Check for:
- Penile deformities
- Prostate disease
- CV status
- Neuro status
- Labs:
- Glucose
- Lipids
- Total testosterone (AM x 2 days)

NOTE: ED = Potential harbinger for cardiovascular or peripheral vascular disease!!

Question 4

How should erectile dysfunction be treated?

Answer 4

Organic: Treat underlying cause

Psychogenic:
PDE5 inhibitors (phosphodiesterase):
- Viagra (sildenafil)
- Stendra (avanafil)
- Cialis (tadalafil)
- Levitra, Staxyn (vardenafil)

• Cautious use in patients with heart disease
• Contraindicated if patient takes nitrates
  (nitrates cause vasodilation;
  PDE5 inhibitors ADD vasodilation)