Erectile dysfunction

Question 1

How do erections normally occur?

Answer 1

• Neuronal release of NO which, via cGMP and Ca²⁺
• Relaxes smooth muscle cells, allowing blood to fill

Question 2

Describe ED?

Answer 2

• Common after 50yrs old
• Often multifactorial
• Often psychological facet: times of stress, anxiety

Question 3

What are the organic causes of ED?

Answer 3

• Big three: smoking, alcohol, diabetes
• Also endocrine, neurological, organ failure and drug causes

Question 4

Name some endocrine causes of ED?

Answer 4

• Hypogonadism
• Hyperthyroidism
• Hyperprolactinaemia

Question 5

Name some neurological causes of ED?

Answer 5

• Cord lesions
• Multiple sclerosis
• Autonomic neuropathy

Question 6

Name some drug causes of ED?

Answer 6

• Digoxin
• Beta blockers
• Diuretics
• Ostrogens
• Antipsychotics
• Antidepressants
• Finasteride
• Narcotics

Question 7

Describe the work up for ED?

Answer 7

• Sexual and psychologial history
• U&Es, LFTs, glucose, TFT, LH, FSH, lipids, tesotsterone

Question 8

Describe the management of ED?

Answer 8

• Treat causes
• Counselling
• Oral phosphodiesterase (PDE5) inhibitors
  
  • Increase cGMP
    
    • Sildenafil
    • Vardenafil
• Vacuum aids
• Prostheses (inflatable or malleable)

Question 9

Problems with sildenafil?

Answer 9

• Food and alcohol upset absorption
• SEs:
  
  • Headache
  • Flushing
  • Dyspepsia
  • Stuffy nose
  • Transient blue-green tingeing of vision

Question 10

Contraindications of PD5 inhibitors?

Answer 10

• Concurrent use of nitrates
• Tachy/bradycardia
• Degenerative retinal disordeers
• Unstable angina/stroke <6 months ago

Question 11

Interactions of PD5 inhibitors?

Answer 11

• Nitrates
• Cytochrome P450 inducers
• Macrolides
• Protease inhibitors
• Theophyllines
• Azole antifungals
• Rifampicin
• Phenytoin
• Carbamazepine
• Phenobarbitol
• Grapefruit juice

Question 12

Most common cause of ED?

Answer 12

Vascular