Erectile Dysfunction Flashcards
Define erectile dysfunction
The inability to achieve and maintain a penile erection for satisfactory sexual intercourse
Erectile dysfunction is more common with increasing age. T/F?
True
Give examples of psychological factors which can cause erectile dysfunction
stress
performance anxiety
depression
Give examples of physiological factors which can cause erectile dysfunction
inadequate blood supply due to atherosclerosis or blood vessel damage from hypertension
type 2 diabetes mellitus
Give examples of neurological factors which can cause erectile dysfunction
stroke, MS, back or pelvic trauma causing direct damage to parasympathetic nerve fibres
Give examples of endocrine factors which can cause erectile dysfunction
hypogonadism
low testosterone
Give examples of medications which can cause erectile dysfunction
Antidepressants e.g. SSRIs, MAOIs, TCAs
Antihypertensives e.g. beta blockers, verapamil, clonidine
Antiarrythmics - digoxin, amiodarone
Diuretics - spironolactone, thiazides
Hormonal - anti-androgens, 5-alpha reductase inhibitors
H2 receptor antagonists
Recreational drugs - alcohol, marijuana, cocaine
Psychogenic erectile dysfunction accounts for approximately what percentage of erectile dysfunction?
10%
Organic erectile dysfunction accounts for approximately what percentage of erectile dysfunction?
90%
What questions should be asked when taking a psychosexual history from a man experiencing erectile dysfunction?
Onset and duration of erectile dysfunction, partial or full erection
Presence of nocturnal and morning erections
Situations in which ED occurs e.g. when with partner, self
Previous history of ED
Sexual orientation and gender identity
Past and current sexual relationships
Current emotional issues
What factors or symptoms would suggest a psychogenic cause of erectile dysfunction?
Younger age Lake of medical history / risk factors Sudden onset Decreased libido Spontaneous erections Symptoms present at specific time e.g. when with partner Major life events Relationship changes Previous psychological history
What factors or symptoms would suggest an organic cause of erectile dysfunction?
Older age
Gradual onset
Normal libido
Loss of nocturnal and early morning erections
Present in all situations e.g. when with partner / stimuli
Risk factors for CVD/DM
Other than a psychosexual history, what other systems checks would you want to discuss in a man presenting with erectile dysfunction?
Cardiovascular history and symptoms
Symptoms of diabetes mellitus
Lower urinary tract symptoms
Social history - relationship with partner, current emotional state, stress, alcohol and drug use
What general examinations would you want to perform in a man presenting with erectile dysfunction and explain the reason for doing these examinations?
Blood pressure
Pulse
BMI
To assess CV risk factors
An examination of the external genitalia should be conducted in a man presenting with erectile dysfunction. What abnormalities should you look for?
Penile abnormalities - premalignant or malignant conditions
Phimosis
Peyronie’s disease
Signs of secondary sexual characteristics
A digital rectal examination may be performed in a man presenting with erectile dysfunction. For which patients would this investigation be indicated?
Men >50 years of age
Hx of prostate cancer
Prostate symptoms
Ejaculatory dysfunction present
What blood tests would you do for a man presenting with erectile dysfunction? Explain your reasoning
Fasting glucose or HbA1c to assess glycemic control
Fasting lipids to calculate 10 years CVD risk
LFTs including GGT (alcohol use)
Total testosterone ( to check for low testosterone)
PSA if >50 years or DRE indicates enlarged prostate
Withdrawal of antipsychotic medication due to drug induced erectile dysfunction requires a review from psychiatry. T/F?
True
What lifestyle modifications should be suggested for a man presenting with erectile dysfunction?
Dietary changes Smoking cessation Reduction in alcohol Increased exercise Suggest counselling or mindfulness to help with stress
What class of drugs are used as first line treatment fo erectile dysfunction and give an example of this?
PDE-5 inhibitors such as sildenafil
Explain the mechanism of action of PDE-5 inhibitors used as a first line treatment for erectile dysfunction.
Inhibit the PDE-5 enzyme in endothelial cells which normally breaks down cGMP, this results in higher levels of cGMP and more smooth muscle relaxation which facilitates an erection
What are the contraindications for the use of PDE-5 inhibitors to treat erectile dysfunction?
Nitrates and granulate cyclase stimulators
Severe or unstable heart disease
Non-arteric anterior ischaemic optic neuropathy
Hypotension
Unstable angina or angina occurring during sexual intercourse
Recent stroke or mI
What are the cautions for the use of PDE-5 inhibitors to treat erectile dysfunction?
Stratify CVD risk according to Princeton consensus 2
Left ventricular outflow obstruction
Anatomical penile abnormalities
Predisposition to priapism
How long before sexual activity does sildenafil need to be taken and what is its duration of action?
One hour before
4-5 hours
Priapism is the persistence of an erection for more than how many hours?
4 hours
Why is priapism dangerous?
Can cause necrosis if blood is not drained
What are the common side effects of PDE-5 inhibitors used to treat erectile dysfunction?
Back pain Dyspepsia Flushing Migraine Myalgia Nasal congestion Dizziness Nausea Vomiting
What are the uncommon yet serious side effects of PDE-5 inhibitors used to treat erectile dysfunction?
Visual disturbances including non-arteric anterior ischaemic optic neuropathy
sudden hearing loss
priapism
Although patients are given a prescription, they must pay for PDE-5 inhibitors to treat erectile dysfunction themselves. In what cases are patients prescribed these drugs for free?
DM PD MS Polio Single gene neurological disease Spinal cord injury Spina bifida Renal dialysis Radial pelvic surgery Prostate cancer Treatment initiated before 1998 Severe stress secondary to ED (assessed by psychiatrist)
What is the second line medication for the treatment of erectile dysfunction?
Synthetic prostaglandin E1 such as alprostadil
What is the mechanism of action of synthetic prostaglandin E1 analogues used as the second line treatment for erection dysfunction?
Increases cGMP levels to increase smooth muscle relaxation to facilitate an erection
Via what routes can synthetic prostaglandin E1 analogues (the second line treatment for erectile dysfunction) be administered?
Directly into penis via a small pellet inserted into the urethral opening (MUSE)
Direct intracavernosal injection
Other than medication, what secondary care treatments can be offered for erectile dysfunction?
Vacuum erection device
Penile prosthesis surgery
What are the side effects of vacuum erection devices (used to treat erectile dysfunction)?
Pain
Bruising
penile numbness
skin necrosis
