Erectile Dysfunction Flashcards
What is erectile dysfunction?
Inability to achieve/maintain an erection that enables sexual activity with penetration
What can erectile dysfunction be a symptom of?
Wide range of physical and psychological conditions
Is erectile dysfunction common?
Yes
Becomes more prevalent with age
What is tumescence?
Normal erectile dyfunction
What does tumescence involve?
Redirection of blood from pelvic vascular bed into erectile tissue of penis
What triggers tumescence?
Neurological stimuli
What mediates tumescence?
Array of factors
- Hormonal
- Chemical
- Psychological
Describe the erectile tissue of the penis
2 spongy cigar shaped structures = corpora cavernosae
- Network of sinusoids made of trabecular smooth muscle
- Lined by endothelial cells
What happens to the corpora cavernosae during an erection?
Trabecular smooth muscle relaxes
Blood flows into sinusoids
What limits the expansion of erectile tissue?
Tunica albuginea = strong fibro-elastic casing enveloping corpora cavernosae
What results in the rigidity of the penis during an erection?
Tunica albuginea limits expansion of erectile tissue > increased pressure in sinusoids > blocks outflow of venous blood from penis > blood trapped
What are the two neuronal mechanisms that activate the flow of blood during an erection?
Central/psychogenic sensory inputs generated by erotic stimuli
- Relayed to lower spinal cord via limbic system
Peripheral/reflexogenic sensory inputs produced in response to tactile stimulation of genital region
- Relayed through reflex arc to sacral nerve rooths
- Transmitted via parasympathetic nerve fibres to penis
What are the local factors regulating erectile function?
Nitric oxide produced by vascular endothelium
Testosterone
- Maintains levels of enzymes that catalyses production of nitric oxide
- Libido
When does an erection weaken?
Cyclic GMP metabolised by phosphodiesterases
Sympathetic nerve activity increases during ejaculation
Trabecular smooth muscle and erectile tissue contracts > blood flows out of penis
What is detumescence?
Process of weakening of erection after ejaculation
What causes erectile dysfunction?
Any condition that interferes with normal mechanism of penile tumescence
Often >1 underlying cause
Why is a full medical assessment necessary when a patient presents with erectile dysfunction?
Can be 1st symptom of underlying physical disease
Describe how atherosclerosis and its risk factors can cause erectile dysfunction
Cause endothelial dysfunction > can impact blood flow during tumescence
What are common conditions associated with vascular causes of erectile dysfunction?
Diabetes
Renal failure
Peripheral vascular disease
Sleep apnoea
What are common neurological causes of erectile dysfunction?
Spinal cord disease
Stroke
Dementia
Local interruption in nerve supply to penis by pelvic surgery/trauma
What are common drugs that can cause erectile dysfunction?
Anti-depressants
Anti-hypertensives
Alcohol
Recreational drugs
What are less common hormonal conditions that can cause erectile dysfunction?
Testosterone deficiency
High prolactin levels
What are psychological factors that can affect erectile dysfunction?
Anxiety
Depression
Relationship problems
How can anxiety lead to impaired sexual function?
Increased sympathetic tone > impaired smooth muscle relaxation during tumescence
How can an inability to achieve tumescence occur in men with normal erectile function?
Alcohol intake
Sleep deprivation
What are some general key points when interviewing someone who presents with erectile dysfunction?
Ask open question Clarify exact nature of presenting problem Differentiate erectile dysfunction from - Loss of libido - Inability to reach orgasm - Difficulties with ejaculation
What is the likely nature of the cause if erectile dysfunction has a gradual onset?
Physical
What is the likely nature of the cause if erectile dysfunction has an acute onset?
Psychogenic
What is the likely nature of the cause if erectile dysfunction has an intermittent nature?
Psychogenic basis
Alcohol
Lack of sleep
How do you interrogate the quality of erectile dysfunction?
Linked with severity
How do you interrogate the severity of erectile dysfunction?
Ask about degree of rigidity of erections
Does it take longer to achieve an erection?
Are erections of shorter than before?
Is the problem severe enough to prevent intercourse?
How do you interrogate the time course of erectile dysfunction?
When did it start?
Was the onset sudden or gradual?
Does it occur intermittently or is it present on every occasion?
How do you interrogate the context of erectile dysfunction?
If man has >1 sexual partner, does it occur with 1 and not another?
Is man able to achieve an erection with masturbation?
Do nocturnal or early morning erections occur?
How do you interrogate the aggravating factors of erectile dysfunction?
Does anything seem to have precipitated it?
Does anything seem to make it worse?
Does anxiety impact on the ability to achieve an erection?
How do you interrogate the relieving factors of erectile dysfunction?
What has been tried to help with the problem?
If medication has been tried, how effective was it?
How do you interrogate the associated features of erectile dysfunction?
Any difficulties with - Libido - Orgasm - Ejaculation Past medical and surgical history Medications Smoking
