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GU > Lecture 12: Male Sexual Dysfunction > Flashcards

Lecture 12: Male Sexual Dysfunction Flashcards

1
Q

What components are required for NORMAL male sexual function?

A
  1. Libido
  2. Penile erection
  3. Ejaculation
  4. Detumescence
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2
Q

What are the two neuro pathways that control erection?

A
  • Early males: Peripheral (reflexogenic) S2-S4
  • Mature males: Central (Psychogenic) T11-L2

AKA when you’re young, touching it makes it erect.

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3
Q

What is the primary neurotransmitter in erection?

A

Nitric Oxide, which promotes vascular relaxation to start and maintain an erection.

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4
Q

What part of the penis becomes engorged with blood and what keeps it engorged?

A
  • Corpus cavernosa gets engorged
  • Trabecular smooth muscle compresses to keep the blood in.
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5
Q

What part of the nervous system controls ejaculation?

A

Sympathetic NS

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6
Q

What 3 things mediate detumescence?

A
  • NE
  • Endothelin
  • Smooth muscle contraction
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7
Q

Is ED part of the aging process?

A

No!

However, does occur in older men generally.

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8
Q

What organ disease can affect ED?

A

CV disease

Vascular disorders in general.

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9
Q

What are the 3 primary mechanisms that result in ED?

A
  1. Can’t initiate erection (psycho, endo, neuro)
  2. Can’t fill penile tissue (arteriogenic)
  3. Can’t store blood properly (venoocclusive)
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10
Q

In a majority of ED cases, what are the common risk factors?

A
  1. DM
  2. Atherosclerosis
  3. Medication
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11
Q

What is the MC organic cause of ED?

A

Vasculogenic

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12
Q

What two endocrine abnormalities can cause ED?

A
  • Low testosterone
  • Increased prolactin
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13
Q

What medications are known to cause ED?

A
  • Thiazides
  • BBs
  • Hormones (estrogen, GnRH)
  • Antidepressants (SSRIs & TCAs)
  • H2 antagonists
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14
Q

What managment option should we do if there is no response to oral meds for ED?

A

Direct injection of meds

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15
Q

If there is no response to injections for ED, what diagnostic imaging might be indicated?

A
  • Duplex US
  • Cavernosography
  • Arteriography
  • Penile nocturnal detumescence study
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16
Q

What is first-line managment for psychogenic ED?

A
  • Sex therapy
  • Stress reduction
17
Q

What are the pharmacologic treatments for ED?

A
  • Oral PDE-5 inhibitors
  • Injection therapy
  • Testosterone replacement therapy
18
Q

When is testosterone replacement therapy useful for ED?

A
  • Documented hypogonadism
  • Low testosterone levels
19
Q

What kind of patient should we be extremely cautionary of giving testosterone to?

A

Prostate issues

It is a prostate GROWTH factor

20
Q

What are the preferred forms of testosterone replacement?

A
  • Transdermal
  • IM injections

Both are cheap and provide stable levels of testosterone.

21
Q

Describe the frequency of testosterone monitoring.

A
  1. Measure 2-3 months after starting or changing dose.
  2. 6-12 months for maintenance.
  3. Midway for injections, anytime for daily.
22
Q

What are the primary DDIs for testosterone?

A
  • Warfarin
  • GnRH agonists/antagonists
  • Steroids
23
Q

What is the MOA of a PDE-5 inhibitor?

A

Degradation of cGMP, which allows sustained inflow to the penis.

First-line treatment for most patients.

Similar efficacy, but patient response varies a lot.

24
Q

What are the 4 hour PDE-5 inhibitors?

A
  • Sildenafil (1 hour prior NPO)
  • Vardenafil (1 hour prior NPO)
  • Avanafil (30 mins prior)

Vardenafil has an ODT form.

25
Q

What is the extended PDE-5 inhibitor?

A

Tadalafil, which can be taken with food.

Also used for daily tx of LUTS due to BPH.

LUTS = lower urinary tract smyptoms

26
Q

What are the common SEs for PDE-5 inhibitors?

A
  • HA
  • Flushing
  • Dyspepsia
  • Dizziness and hypotension
27
Q

What are the primary contraindications to PDE-5 inhibitors?

A
  • Nitrates (all of them)
  • Severe CV
28
Q

What do you inject into a penis for vasodilation?

A

Prostaglandins, into the corpus cavernosa.

29
Q

What drug is most often implicated in cases of poor male libido?

A

SSRIs

5-alpha-reductase inhibitors, ETOH

30
Q

What is the MC ejaculatory disorder and the criteria?

A
  • Premature ejaculation.
    1. Brief ejaculatory latency
    2. Loss of control to delay or stop ejaculation
    3. Psychological distress in patient and/or partner
31
Q

What is the treatment for primary premature ejaculation?

A
  • Behavioral modifications
  • Counseling
  • Medications (SSRIs first-line)
32
Q

What is the treatment for delayed ejaculation?

A
  • Counseling
  • Sex therapy
  • Med ADJUSTMENTS
33
Q

When is retrograde ejaculation commonly seen?

A

Post BPH surgery.

Dry orgasm

34
Q

When is treatment for retrograde ejaculation recommended?

A

If you want fertility.

  • Imipramine
  • Chlorpheniramine
  • Pseudoephedrine

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