Erectile Dysfunction

Question 1

% of men over 40% with ED

Answer 1

20%

ref: andrology Aus

Question 2

Causes of ED

Answer 2

Vascular
–> atherosclerosis

Metabolic problems
–>Diabetes, HTN, high lipids, obesity,

Smoking
Post surgical e.g. prostate radiation
Medications
–> SSRI’s

Endocrine
–> Androgen deficiency e.g. Klinefelters

Psychological e.g. depression, anxiety

Sometimes alcohol & drugs

Neurological

• -> MS
• -> Parkinson’s Disease

Trauma

• -> Pelvic trauma
• -> Prolonged bike riding

(ref: andrology Aus)

Question 3

Contraindications for PDE-5 Inhibitors?

Other tx for ED if PDE-5 doesn’t work?

Answer 3

Nitrates = absolute.
Other to be cautious
–> active coronary ischaemia, congestive heart failure and borderline low blood pressure, borderline low cardiac volume status, a complicated multi-drug antihypertensive program, and drug therapy that can prolong the half-life of PDE5 inhibitors.

Penile injection of prostaglandin
Penile Prosthesis

(ref: andrology Aus)

Question 4

How do PDE-5 work?

Answer 4

Following sexual stimulation, nitric oxide (NO) activates cyptoplasmic guanylate cyclase, increases cyclic guanosine monophosphate (cGMP), resulting in smooth muscle relaxation and an erection. Phosphodiesterase 5 (PDE5) deactivates cGMP resulting in loss of an erection.

PDE5 inhibitors exert an effect by inhibiting PDE5, increasing cGMP levels and thereby enhancing an erection.

PDE5 inhibitors are effective in about 70% of me

(ref: andrology Aus)

Question 5

Side effects of PDE-5 inhibitors

Answer 5

headaches, flushing, dyspepsia, nasal congestion, backache and myalgia.