Male GU (exam 4) Flashcards
Define ED.
Consistent inability to maintain an erect penis with sufficient rigidity to allow for intercourse
What is the most common sexual problem in men?
ED
What things are required for an erection?
- intact PSNS + somatic nerve supply
- unobstructed arterial flow
- adequate venous constriction
- hormonal simulation
- psychological desire
What are the risk factors for ED?
- sedentary lifestyle
- obesity
- smoking
- medical comorbidities: DM, HTN, obesity, OSA, dyslipidemia, CVD, smoking, RLS
- watching TV
- lower frequency of sexual activity
The main cause of ED is a decrease is arterial flow from progressive vascular disease. What are some meds that can cause it?
-SSRIs, beta blockers, spironolactone, thiazide diuretics, clonidine, ketoconazole, cimetidine
depression and stress can also cause it :(
There are three more causes of ED-what are they?
- neurologic: stroke, SCI, MS
- biking
- endocrine disorders: T deficiency, hypo/hyperthyroidism
What are some labs that can be used in diagnosing ED?
- CBC
- UA
- TSH
- lipid panel
- serum T
- glucose
- prolactin: if serum T or prolactin abnormal, can proceed to FSH and LH
What are some other diagnostics for ED?
- nocturnal penile tumescence testing
- direct injection of vasoactive substances (prostaglandin E1) into penis–> erection if vascular system intact. If no erection, then need US of cavernous arteries, pelvic arteriography, cavernosongraphy
What is the tx for ED with psychogenic causes?
behaviorally oriented sex therapy
What is the tx for ED due to low T?
Testosterone replacement: injection, gel, or patches
What can help ED if the patient is obese?
weight loss
What is the mainstay of tx for ED?
phosphodiesterase-5 inhibitors (PDE-5)
Name some PDE-5s and when they should be taken
- Viagra, Levitra, Cialis: 45-60mins before sexual activity
- Stendra: 15-30mins prior
What is the big contraindication in giving PDE-5s?
If patient is taking nitrates
Side effects of PDE-5s?
Blue vision (viagra), sudden hearing loss
