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LC 3 > LC 3.7 Male Sexual Function and Ageing > Flashcards

LC 3.7 Male Sexual Function and Ageing Flashcards

1
Q

What are the two functions of the testis? What cells does each involve?

A
  • Produce sperm (leydig cells)

* Produce hormones (sertoli cells)

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2
Q

Outline the hormones in the sex steroid axis

A

GnRH
LH
Testosterone

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3
Q

Why does anabolic steroid use lead to infertility?

A

Negative feedback caused by steroid use suppresses endogenous testosterone production. High concentrations needed in the seminiferous tubules for sperm to develop properly.

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4
Q

What is free testosterone responsible for regulating?

A
  • Haematopoesis
    • Muscle development
    • Fat redistribution
    • Hair growth
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5
Q

How do testosterone levels change over a lifetime?

A

Peaks in early twenties, then slowly declines (andropause)

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6
Q

What causes the decreased production of testosterone with age? (andropause)

A
  • Apoptosis of Leydig cells
    • Lack of response to LH
    • Obesity
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7
Q

Why does obesity reduce testosterone levels?

A

Fat produces oestrogen, which negatively feeds back to the sex steroid axis, inhibiting it.

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8
Q

What are the effects of andropause

A
  • Decreased sexual function
    • Mood changes and Fatigue
    • Decreased muscle and Increased fat
    • Decreased bone mineral density
    • Decreased haemoglobin
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9
Q

What are the potential benefits of HRT for men?

A

Decreases fat and increases muscle, which helps mobility.

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10
Q

What are the cons of HRT for men?

A
  • Exercise programmes have the same effect on mobility

* There is a risk of prostate cancer and CVS impact

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11
Q

In what ways is male fertility affected by ageing?

A
  • There is a reduced Sertoli cell function and so reduced sperm quality
    • Increased developmental problem risk
    • Inconsistent effects on fertility; can be preserved but there is a decline
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12
Q

What changes occur to the prostate with age?

A
  • Reduced secretion of seminal plasma

* Prostatic neoplasia occurs

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13
Q

What types of prostatic neoplasia occur, and what is the prevalence of each in 70 year old men?

A
  • Benign prostatic hyperplasia - 70%

* Prostate cancer - 3%

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14
Q

What does reduced secretion of seminal plasma with age cause?

A
  • Reduced ejaculate volume
    • Thicker semen
    • Reduced force of ejaculation
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15
Q

What changes in sexual function occur with age?

A
  • Decreased libido
    • Prolonged arousal and decreased sensitivity
    • Reduced erectile rigidity
    • Decreased intensity of orgasm
    • Increased refractory period
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16
Q

What are the causes of erectile dysfunction?

A

Failure of cavernosal smooth muscle relaxation:
• Loss of desire
• Nerve damage
• Failure of smooth muscle to relax (fibrosis?)
• Blocked or narrowed arteries

17
Q

How does an erection occur?

A
  • Stimulus occurs
    • NO released
    • cGMP formed
    • Vascular smooth muscle relaxes
    • Sinusoids of corpora cavernosa swell with blood
    • Swollen sinusoids impinge upon emissary veins, trapping blood inside
    • Smooth muscle in sinusoids relaxes
18
Q

What are the risk factors of erectile dysfunction?

A
  • Age
    • Diabetes and hyperlipidaemia
    • Depression
    • Peripheral vascular disease
    • IHD
    • Hypertension
19
Q

What can cause smooth muscle dysfunction?

A
  • Toxins

* Diabetes

20
Q

What is indicative of erectile dysfunction being of a psychological cause?

A
  • Sudden onset
    • Relationship issue
    • Morning wood present
    • Young patient
    • Intermittent problem
21
Q

How is erectile dysfunction diagnosed?

A 
Check for risk factors
  •  Check BP
  •  Check size of testes (small =hypogonadism)
  •  Check blood sugar for diabetes
  •  Check lipid profile 
  •  Check testosterone level
22
Q

When must testosterone levels be checked and why?

A

In the morning due to diurnal variation

23
Q

What is the treatment for ED?

A
  • Change lifestyle/situation to reduce stress, lose weight, stop smoking, etc.
    • Drugs to combat underlying causes (e.g. ACE inhibitors for hypertension or antidepressants)
    • Psychosexual therapy
    • Direct pharmacological
24
Q

What pharmacological options are available for the treatment of ED?

A 
Centrally acting (uncommon)
  •  Apomorphine (dopamine antagonist)

Smooth muscle relaxants: phosphodiesterase 5 inhibitors (PDE5Is)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

Intra-cavernosal injections
• Prostaglandin E1

25
Q

Outline the cell biology of smooth muscle relaxation during erections.

A
  • NO is released by endothelial cells and cavernous nerves
    • NO activates guanylate cyclase
    • Guanylate cyclase converts GTP into cGMP
    • cGMP-specific protein kinases are activated
    • This phosphorylates proteins which then pump calcium out of the cell or into SR
    • Smooth Muscle relaxes
26
Q

How do PDE5Is work? What is its efficacy rate?

A
  • Phosphodiesterase 5 usually breaks cGMP down into 5’GMP
    • PDE5Is inhibit this breakdown, thus maintaining higher levels of cGMP
    • Cavernous smooth muscle relaxes

70% of men see improvement, 50% if diabetic

27
Q

What are the contraindications to PDE5I use?

A
  • Use of nitrate medication
    • Severe cardiac disease
    • Use of alpha blockers
28
Q

Name an alpha blocker that shouldnt be used with PDE5Is

A

tadalafil

29
Q

What are the side effects of PDE5Is?

A

Headaches and facial flushing

30
Q

What are the physical therapy options for treating ED?

A
  • Penile implant
    • Vacuum constriction device
    • PGE1 injections

LC 3 (12 decks)

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