Erectile Dysfunction

Question 0

if hypogonadism or loss of libido (in evaluation of ED)

Answer 0

order serum testosterone, prolactin levels, thyroid profile

Question 1

Risk factors for erectile dysfunction

Answer 1

• most important: those that contribute to atherosclerosis (htn, smoking, hyperlipidemia, diabetes)
• meds: antihypertensives (may indirectly lower intracavernosal pressure by lowering systemic bp)
• heme: sickle cell dz
• hx of pelvic sx or perineal trauma
• alcohol abuse
• any cause of hypogonadism/low testosterone state (including hypothyroidism)
• congenital penile curvature

Question 2

Treatment of ED

Answer 2

• underlying cause (esp atherosclerotic risk factors)
• 1st line: phosphodiesterase inhibitors sildenafil citrate (Viagra); promotes penile smooth muscle relaxation; contraindicated w use of nitrates bc together can cause profound hypotension
• hormonal replacement (testosterone) in pts w documented hypogonadism
• psychological evals/therapy