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General Practice > Erectile Dysfunction > Flashcards

Erectile Dysfunction Flashcards

1
Q

Define erectile dysfunction

A

The inability to achieve and maintain a penile erection for satisfactory sexual intercourse

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2
Q

Erectile dysfunction is more common with increasing age. T/F?

A

True

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3
Q

Give examples of psychological factors which can cause erectile dysfunction

A

stress
performance anxiety
depression

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4
Q

Give examples of physiological factors which can cause erectile dysfunction

A

inadequate blood supply due to atherosclerosis or blood vessel damage from hypertension
type 2 diabetes mellitus

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5
Q

Give examples of neurological factors which can cause erectile dysfunction

A

stroke, MS, back or pelvic trauma causing direct damage to parasympathetic nerve fibres

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6
Q

Give examples of endocrine factors which can cause erectile dysfunction

A

hypogonadism

low testosterone

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7
Q

Give examples of medications which can cause erectile dysfunction

A

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

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8
Q

Psychogenic erectile dysfunction accounts for approximately what percentage of erectile dysfunction?

A

10%

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9
Q

Organic erectile dysfunction accounts for approximately what percentage of erectile dysfunction?

A

90%

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10
Q

What questions should be asked when taking a psychosexual history from a man experiencing erectile dysfunction?

A

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

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11
Q

What factors or symptoms would suggest a psychogenic cause of erectile dysfunction?

A 
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
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12
Q

What factors or symptoms would suggest an organic cause of erectile dysfunction?

A

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

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13
Q

Other than a psychosexual history, what other systems checks would you want to discuss in a man presenting with erectile dysfunction?

A

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

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14
Q

What general examinations would you want to perform in a man presenting with erectile dysfunction and explain the reason for doing these examinations?

A

Blood pressure
Pulse
BMI
To assess CV risk factors

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15
Q

An examination of the external genitalia should be conducted in a man presenting with erectile dysfunction. What abnormalities should you look for?

A

Penile abnormalities - premalignant or malignant conditions
Phimosis
Peyronie’s disease
Signs of secondary sexual characteristics

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16
Q

A digital rectal examination may be performed in a man presenting with erectile dysfunction. For which patients would this investigation be indicated?

A

Men >50 years of age
Hx of prostate cancer
Prostate symptoms
Ejaculatory dysfunction present

17
Q

What blood tests would you do for a man presenting with erectile dysfunction? Explain your reasoning

A

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

18
Q

Withdrawal of antipsychotic medication due to drug induced erectile dysfunction requires a review from psychiatry. T/F?

A

True

19
Q

What lifestyle modifications should be suggested for a man presenting with erectile dysfunction?

A 
Dietary changes
Smoking cessation
Reduction in alcohol
Increased exercise
Suggest counselling or mindfulness to help with stress
20
Q

What class of drugs are used as first line treatment fo erectile dysfunction and give an example of this?

A

PDE-5 inhibitors such as sildenafil

21
Q

Explain the mechanism of action of PDE-5 inhibitors used as a first line treatment for erectile dysfunction.

A

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

22
Q

What are the contraindications for the use of PDE-5 inhibitors to treat erectile dysfunction?

A

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

23
Q

What are the cautions for the use of PDE-5 inhibitors to treat erectile dysfunction?

A

Stratify CVD risk according to Princeton consensus 2
Left ventricular outflow obstruction
Anatomical penile abnormalities
Predisposition to priapism

24
Q

How long before sexual activity does sildenafil need to be taken and what is its duration of action?

A

One hour before

4-5 hours

25
Q

Priapism is the persistence of an erection for more than how many hours?

A

4 hours

26
Q

Why is priapism dangerous?

A

Can cause necrosis if blood is not drained

27
Q

What are the common side effects of PDE-5 inhibitors used to treat erectile dysfunction?

A 
Back pain
Dyspepsia
Flushing
Migraine
Myalgia
Nasal congestion
Dizziness
Nausea
Vomiting
28
Q

What are the uncommon yet serious side effects of PDE-5 inhibitors used to treat erectile dysfunction?

A

Visual disturbances including non-arteric anterior ischaemic optic neuropathy
sudden hearing loss
priapism

29
Q

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?

A 
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)
30
Q

What is the second line medication for the treatment of erectile dysfunction?

A

Synthetic prostaglandin E1 such as alprostadil

31
Q

What is the mechanism of action of synthetic prostaglandin E1 analogues used as the second line treatment for erection dysfunction?

A

Increases cGMP levels to increase smooth muscle relaxation to facilitate an erection

32
Q

Via what routes can synthetic prostaglandin E1 analogues (the second line treatment for erectile dysfunction) be administered?

A

Directly into penis via a small pellet inserted into the urethral opening (MUSE)
Direct intracavernosal injection

33
Q

Other than medication, what secondary care treatments can be offered for erectile dysfunction?

A

Vacuum erection device

Penile prosthesis surgery

34
Q

What are the side effects of vacuum erection devices (used to treat erectile dysfunction)?

A

Pain
Bruising
penile numbness
skin necrosis

General Practice (5 decks)

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