Impotence Flashcards
How do erections happen
Erections result from neuronal release of nitric oxide (NO) which via cGMP and ca2+ hyperpolarises and thus relaxes vascular and trabecular smooth muscle cells allowing engoregment
Organic cause of impotence
Smoking alcohol and diabetes as it reduces the NO and autonomic neuropathy
Endocrine: hypogonadism , hyperthyroidism , inc prolactin,
Neurological: spinal cord lesions, MS, autonomic neuropathy, pelvic surgery
Radiotherapy, atheroma, renal or hepatic failure, prostate hyperplasia, penile abnormalities:post-priapism or Peyronie’s
Drugs: digoxin, antidepressants, beta blockers, anti-psychotics, estrogens, finesteride and narcotics
Work up
Sexual and psych hx
U&E, LFT, glucose, TFT, LH, FSH, lipids, testosterone, prolactin, +/- Doppler
Is penile arterial pressure enough for inflow
Does the penis have sensation - CNS problems
Is the veno-occlusive mechanisms okay
Tx
Reassure Treat underlying cause Counselling Med: oral phophodiesterase ihibitor Sildenafil
CI and cautions in PD5 inhibitors
CI: concurrent use of nitrates BP high or systolic <90/ arrhythmia Degenerative retinal disorders Unstable angina/stroke MI Cautions: Bleeding, peptic ulcer Angina Marked hepatic or renal impairment Peyronies Cavernosal fibrosis Risk of priaprism Use of complex antihypertensives Dyspnoea on minimal effort
What is male hypogonadism
Failure of the testes to produce testosterone or sperm or both
Features of male hypogonadism
Small testes, dec libido impotence, loss of pubic hair, dc muscle bulk, inc fat, gynaecomastia, osteoporosis, dec mood
If prepubertal - virilisation, incomplete puberty, eunuchoid body : reduced 2ndary sexual characteristic.
Causes of male hypogonadism
Primary hypogonadism
Testicular failure - local trauma, torsion, chemo, post-orchitis - mum, HIV leprosy, renal failure, liver cirrhosis, klinefelters,
Secondary hypogonadism
Dec gonadotropins LH and FSH, hypopituitarism, prolactinoma, kallamans syndrome, systemic illness, prayer-willi
