Erectile dysfunction

Question 1

What is the innervation of an erection?

Answer 1

Parasympathetic stimulation from the pudendal nerve (S2-4) causes the erection
Sympathetic stimulation from T10-L2 leads to ejactulation

Question 2

What are the risk factors for erectile dysfunction?

Answer 2

Smoking
Obesity
Hypertension
Diabetes
Previous pelvic surgery

Question 3

What are the causes of erectile dysfunction?

Answer 3

Vascular - Atherosclerosis, CVD, diabetes, hypertenion
Iatrogenic - surgical, anti-hypertensives, anti-depressants
Psychogenic - depression, anxiety
Endocrine - hypogonadism
Neurological - parkinsons, stroke, MS

Question 4

What examinations should be performed for erectile dysfunction?

Answer 4

Complete genital examination including DRE

Examination of secondary sexual characteristics .e.g. gynecomastia, body hair distribution

Question 5

What investigations can be done for erectile dysfunction?

Answer 5

Serum testosterone
Fasting glucose and lipid profile
Imaging can include:
-ultrasound of cavernous arteries
-Neurological studies

Question 6

What is the management of erectile dysfunction?

Answer 6

Lifestyle:
-Lose weight, stop smoking, reduce alcohol, increase exercise
Medication:
-1st line is PDE-5 inhibitors such as sildenafil (PRN)
Inhibiting PDE means that cGMP is not broken down and this leads to prolonged smooth muscle relaxation
When medication is ineffective can use vaccum devices to engorge the penis with blood or implantable penile prosthesis