Erectile Dysfunction & Infertility

Question 1

what is the inability to attain or sustain an erection satisfactory for sexual intercourse

Answer 1

erectile dysfunction

Question 2

what are most erectile dysfunction related to

Answer 2

vascular, neurologic, psychologic and hormonal disorders
drug use can also be a cuase

Question 3

what are risk factors for erectile dysfunction

Answer 3

DM
HTN
hypercholesterolemia
ASCVD
s/p surgical or radiation tx of prostate CA
depression (cause/effect)

Question 4

what are the types of ED

Answer 4

first degree - man has never been able to attain or sustain an erection since childhood or puberty
second degree - acquired later in life by man who previously was able to attain erections

Question 5

what are psychological causes of ED

Answer 5

anxiety
guilt
depression
relational conflict or distress

Question 6

what is secondary ED

Answer 6

may relate to performance anxiety, stress or depression

Question 7

what is psychogenic ED

Answer 7

situational, involving particular place, time or partner

Question 8

what are the most common Vascular disorders leading to ED

Answer 8

atherosclerosis of cavernous arteries of penis
primary source: smoking or diabetes

Question 9

What can priapism cause

Answer 9

fibrosis or corpora cavernosa and impairment of penile blood flow necessary for erection.

Question 10

what does veno-occulsive dysfunction permit

Answer 10

venous leakage; results in inability to maintain erection

Question 11

what are neurologic disorders that can lead to ED

Answer 11

stroke, partial complex seizures, multiple sclerosis, peripheral and autonomic neuropathies, spinal cord injuries, parkinson’s disease
diabetic neuropathy and surgical injury are particularly common causes

Question 12

What are commonly used drugs that can cause ED

Answer 12

antihypertensives: Beta-blockers, clonidine, loops, spironolactone, thiazide
CNS drugs - alcohol, anxiolytics, cocaine, monoamine oxidase inhibitors, opioids, SSRI, TCAs
amphetamines, 5Alpha-reductase inhibitors, antiandrogens, chemo, anticholinergics, estrogens, etc

Question 13

what labs are usually low in the morning with ED

Answer 13

testosterone level, prolactin and luteinizing hormone

Question 14

what is the treatment of ED

Answer 14

treat underlying causes
drugs - usually PDE5I
vacuum erection device, intra-cavernosal injection or intra-urethral prostaglandin E1

Question 15

what are the first line treatment for ED

Answer 15

oral phosphodiesterase inhibitor

Question 16

what medications promote cGMP-dependent smooth muscle relaxation

Answer 16

Oral phosphodiesterase inhibitors
Sildenafil, verdenafil, avanafil, tadalafil

Question 17

what are the labs for male infertility

Answer 17

semen analysis x2; collection post 48-72 hours of abstinence
sperm count
semen volume
motility
morphology

Question 18

what can affect sperm motility

Answer 18

varicocele (heat?)
anti-sperm antibodies
infection
drugs
duct obstruction

Question 19

what can affect sperm morphology

Answer 19

varicocele
infection
exposure to chemicals

Question 20

What is the treatment of male infertility

Answer 20

education regarding time of intercourse, spermicide avoidance, stop offending meds, treat infections
varicocelectomy
HcG for hypogonadotropic hypogonadism of FSH therapy
meds vs surgical correction
assisted reproduction