Erectile Dysfunction

Question 1

Define Erectile Dysfunction

Answer 1

Erectile dysfunction (ED) is defined as the consistent or recurrent inability to acquire or sustain an erection of sufficient rigidity or duration for sexual intercourse

Question 2

Erectile Dysfunction Epidemiology

Answer 2

In men this is the most common sexual problem. The overall prevalence (20-75 years) is 16%, with 8% in those aged 20-30 years and 37% in those 70-75 years.

Question 3

Erectile Dysfunction Causes

Answer 3

• Cardiovascular disease
• Testosterone deficiency
• Medications
• Psychological problems
• Neurologic Disease

Question 4

Common Medications that can cause Erectile Dysfunction

Answer 4

8/20 of the most commonly prescribed medications list ED as a side effect.

• Antidepressants (esp SSRIs)
• Sympathetic blockers such as clonidine, guanethidine or methyldopa
• Thiazide diuretics
• Ketoconazole (treat tinea corporis)
• Cimetidine (H2-receptor antagonist to inhibit stomach acid production)

Question 5

Psychological Causes of Erectile Dysfunction

Answer 5

• Stress
  
  • Anti-depressants
  • Depression

Question 6

Neurologic Disease Causes of Erectile Dysfunction

Answer 6

• Stroke spinal cord or back injury
  
  • MS
  • Dementia

Question 7

Assessment in Erectile Dysfunction

Answer 7

• History and physical examination
  * Depression
  * HTN
  * Smoking
  * Drugs
  * Sexual history
  * Pelvic neuromuscular disease
  * Injury
  * Surgery
  • Laboratory tests
    
    • Lipids
    • Glucose
    • Testosterone
    • Prolactin

Question 8

Management of Erectile Dysfunction

Answer 8

• Weight loss & physical activity
  
  • Counselling
  • Pharmacotherapy
    
    • First-line
      
      • Oral PDE5 inhibitors
    • Second-line
      
      • Intracavernosal injections or urethral suppository
      • OR Vacuum erection device
    • Third-line
      
      • Intracavernosal combinations
    • Forth-line
      
      • Penile implant

Question 9

Overview of PDE5 inhibitors

Answer 9

• Inhibit cGMP which increases nitric oxide in the vasculature, relaxing smooth muscle and increasing blood to the penis
  
  • SE: Include headache, flushing and dyspepsia
  • CI: hypotension with nitrates

Question 10

Intracavernosal injections or urethral suppository used as second line for Erectile Dysfunction

Answer 10

Prostaglandin E1 (Eg. alprostadil)
            * Urethral suppository or injectible