Erectile Dysfunction

Question 1

What is erectile dysfunction?

Answer 1

Inability to achieve/maintain an erection that enables sexual activity with penetration

Question 2

What can erectile dysfunction be a symptom of?

Answer 2

Wide range of physical and psychological conditions

Question 3

Is erectile dysfunction common?

Answer 3

Yes

Becomes more prevalent with age

Question 4

What is tumescence?

Answer 4

Normal erectile dyfunction

Question 5

What does tumescence involve?

Answer 5

Redirection of blood from pelvic vascular bed into erectile tissue of penis

Question 6

What triggers tumescence?

Answer 6

Neurological stimuli

Question 7

What mediates tumescence?

Answer 7

Array of factors

• Hormonal
• Chemical
• Psychological

Question 8

Describe the erectile tissue of the penis

Answer 8

2 spongy cigar shaped structures = corpora cavernosae

• Network of sinusoids made of trabecular smooth muscle
• Lined by endothelial cells

Question 9

What happens to the corpora cavernosae during an erection?

Answer 9

Trabecular smooth muscle relaxes

Blood flows into sinusoids

Question 10

What limits the expansion of erectile tissue?

Answer 10

Tunica albuginea = strong fibro-elastic casing enveloping corpora cavernosae

Question 11

What results in the rigidity of the penis during an erection?

Answer 11

Tunica albuginea limits expansion of erectile tissue > increased pressure in sinusoids > blocks outflow of venous blood from penis > blood trapped

Question 12

What are the two neuronal mechanisms that activate the flow of blood during an erection?

Answer 12

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

Question 13

What are the local factors regulating erectile function?

Answer 13

Nitric oxide produced by vascular endothelium
Testosterone
- Maintains levels of enzymes that catalyses production of nitric oxide
- Libido

Question 14

When does an erection weaken?

Answer 14

Cyclic GMP metabolised by phosphodiesterases
Sympathetic nerve activity increases during ejaculation
Trabecular smooth muscle and erectile tissue contracts > blood flows out of penis

Question 15

What is detumescence?

Answer 15

Process of weakening of erection after ejaculation

Question 16

What causes erectile dysfunction?

Answer 16

Any condition that interferes with normal mechanism of penile tumescence
Often >1 underlying cause

Question 17

Why is a full medical assessment necessary when a patient presents with erectile dysfunction?

Answer 17

Can be 1st symptom of underlying physical disease

Question 18

Describe how atherosclerosis and its risk factors can cause erectile dysfunction

Answer 18

Cause endothelial dysfunction > can impact blood flow during tumescence

Question 19

What are common conditions associated with vascular causes of erectile dysfunction?

Answer 19

Diabetes
Renal failure
Peripheral vascular disease
Sleep apnoea

Question 20

What are common neurological causes of erectile dysfunction?

Answer 20

Spinal cord disease
Stroke
Dementia
Local interruption in nerve supply to penis by pelvic surgery/trauma

Question 21

What are common drugs that can cause erectile dysfunction?

Answer 21

Anti-depressants
Anti-hypertensives
Alcohol
Recreational drugs

Question 22

What are less common hormonal conditions that can cause erectile dysfunction?

Answer 22

Testosterone deficiency

High prolactin levels

Question 23

What are psychological factors that can affect erectile dysfunction?

Answer 23

Anxiety
Depression
Relationship problems

Question 24

How can anxiety lead to impaired sexual function?

Answer 24

Increased sympathetic tone > impaired smooth muscle relaxation during tumescence

Question 25

How can an inability to achieve tumescence occur in men with normal erectile function?

Answer 25

Alcohol intake

Sleep deprivation

Question 26

What are some general key points when interviewing someone who presents with erectile dysfunction?

Answer 26

Ask open question
Clarify exact nature of presenting problem
Differentiate erectile dysfunction from 
- Loss of libido
- Inability to reach orgasm
- Difficulties with ejaculation

Question 27

What is the likely nature of the cause if erectile dysfunction has a gradual onset?

Answer 27

Physical

Question 28

What is the likely nature of the cause if erectile dysfunction has an acute onset?

Answer 28

Psychogenic

Question 29

What is the likely nature of the cause if erectile dysfunction has an intermittent nature?

Answer 29

Psychogenic basis
Alcohol
Lack of sleep

Question 30

How do you interrogate the quality of erectile dysfunction?

Answer 30

Linked with severity

Question 31

How do you interrogate the severity of erectile dysfunction?

Answer 31

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?

Question 32

How do you interrogate the time course of erectile dysfunction?

Answer 32

When did it start?
Was the onset sudden or gradual?
Does it occur intermittently or is it present on every occasion?

Question 33

How do you interrogate the context of erectile dysfunction?

Answer 33

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?

Question 34

How do you interrogate the aggravating factors of erectile dysfunction?

Answer 34

Does anything seem to have precipitated it?
Does anything seem to make it worse?
Does anxiety impact on the ability to achieve an erection?

Question 35

How do you interrogate the relieving factors of erectile dysfunction?

Answer 35

What has been tried to help with the problem?

If medication has been tried, how effective was it?

Question 36

How do you interrogate the associated features of erectile dysfunction?

Answer 36

Any difficulties with
- Libido
- Orgasm
- Ejaculation
Past medical and surgical history
Medications
Smoking