Erectile Dysfunction

Question 1

What is an erection?

Answer 1

An erection is a neurovascular, process of contraction and relaxation of penile structures

Question 2

What systems affect the penis?

Answer 2

Autonomic nervous system and somatic nervous systems

Question 3

What does the somatic nervous system involve?

Answer 3

The somatic nervous system involves the sensation response of penile tissue when stimulated.

Question 4

What determines penile relaxation?

Answer 4

Ejaculation

Question 5

What does the parasympathetic nervous system control?

Answer 5

Initiation of the erection

Question 6

What is the first part of a male’s sexual stimulation?

Answer 6

Penile erction

Question 7

What is the definition of erectile dysfunction:

Answer 7

inability to obtain or sustain an erection to completely satisfy sexual intercourse

Question 8

What processes can be affected during an erection?

Answer 8

Neural, vascular or chemical processes

Question 9

What are psychogenic causes of erectile dysfunction?

Answer 9

Anxiety
Strain in a relationship
Depression
Psychosis/schizophrenia
Treatments for anxiety and depression

Question 10

Organic causes of ED:

Neurogenic disorders

Answer 10

SCI
Stroke
Parkinson’s
Cerebral trauma

These may reduce sexual drive or the inability to obtain sensory involvement needed to obtain a erection

Question 11

Organic causes of ED:

Hormonal Causes

Answer 11

Reduction of androgens both primary and secondary

Question 12

Organic causes of ED:

Surgery

Answer 12

Extensive pelvis surgery or radiation can cause structural damage and nerve dysfunction

Question 13

Organic causes of ED:

Blood flow

Answer 13

Penile arterial insufficiency
Reduction of blood flow
or conditions which cause vascular compromise over time

Question 14

First-Line treatments for ED

Answer 14

PDE-5 inhibitors inhibit the breakdown of responses involved in obtaining and sustaining an erection

The presence of penile stimulation in the PDE-5 inhibitors help to reinforce normal cellular activity in smooth muscle of the penis

Facilitates the initiation and maintenance of erection

Question 15

What are some 1st line medications for ED?

Answer 15

Tadalfil (cialis) 5-20 mg/d

Vardenafil (Levitra) 5-20 mg /d

Sildenafil (Viagra) 25-100 mg/d

Question 16

What are some Second-Line treatments for ED?

Answer 16

Referral to urology
Intracavernosal injection therapy
Prosthesis
Vacuum erection device

Question 17

What are the goals of ED therapy?

Answer 17

Maintain an erection
Achieve sexual satisfaction with sustainable erection

Re-evaluate in 6 months

Determine if there are any cardiac risks have changed

Question 18

What drugs can affect ED?

Answer 18

Alcohol
Nicotine
Tranquilizers
Diuretics
Corticosteroids
Antihistamines
Antiparkinsons
Analgesics
Antidepressants
Antihypertensives
Anticonvulsants

Question 19

What drugs are contraindicated with PDE-5 inhibitors?

Answer 19

Nitrates due to hypotensive effects

Question 20

What are some side effects of PDE-5 inhibitors?

Answer 20

Priapism is a sustained erection/prolonged erction. If untreated can leave to ischemia and permanent damage to penile tissue.

Priapism is common in sickle cell disease

Headache
Flushing
nasal congestion
Dyspepsia
Priapism

Question 21

What are some risks for ED?

Answer 21

Illicit drug use
Prescribed medications
Over-the-counter treatments
Smoking
Comorbid conditions: diabetes, heart disease, hypertension, HLD
Age - andropause

Question 22

What are some patient teaching points and considerations?

Answer 22

Determine the underlying problem, patient, and partner
Discuss the patient and partner’s view of the problem
Discuss pharmacological and nonpharmacological methods of improving ED.
Discuss medical, sexual or psychosocial aspect of ED