Erectile dysfunction

Question 1

What is ED

Answer 1

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual performance.

Question 2

What is pathophys of ED?

Answer 2

Erectinos involve neuron release of NO which causes dilation of blood vessels and relaxation of smooth muscle.
Response to neurovascular stimulation is impaired, due to endothelial dysfunction e.g. atherosclerosis

Question 3

What are causes of ED?

Answer 3

Vascular e.g. atherosclerosis
Diabetes
smoking and alcohol
pelvis surgery, radiation
neurogenic e.g. stroke, MS
endocrine e.g. hypogonadism, pituitary tumours

Question 4

What are risk factors for ED?

Answer 4

CAD
PAD
Psychosexual relationship problems

Question 5

What Ix in ED?

Answer 5

International index of ED: questionnaire which addresses all domains of male sexual dysfunction
Bloods: FBG, lipids, FSH and LH, morning testosterone, prolactin
Doppler US: look at blood flow to penis

Question 6

What is Rx of ED?

Answer 6

Treat cause
Counselling

PDE5 inhibitors e.f. sildenafil which increase cGMP.

Vacuum erection device.