Male Sexual Dysfunction Flashcards
What are the 7 stages of changes in Male Sex organ during intercourse
Libido
Arousal
Penile Tumescence
Copulation
Ejaculation
Orgasm
Détumescence
List 3 disorders associated with Erection
Erectile Dysfunction
Priapism
Erectile deformity
List 3 disorders associated with Ejaculation
-Premature, delayed or retrograde ejaculation
-anorgasmia
- anejaculation
What are two main causes of hypo active sexual disorder
Psychogenic
Low Testosterone
What could be elicited from a medical history that could cue the physician to the cause of hypoactive sexual disorder
Symptoms of endocrine disorder
At what age do male testosterone levels peak?
20years (900ng/dL)
What does the ADAM stand for in the ADAM Questionnaire
Androgen deprivation in the aging male
What qualifies a positive result on the ADAM Questionnaire
An affirmative response to Q1 (Do you have decreased libido)
Q7 (Are your erections less strong)
Or 3 of any other questions is a positive result
How do you evaluate the suspected hypogonadal patient?
Early Morning Total Testosterone
(<12.1 nMol/L or 348.3 ng/dl)
Repeat T levels & Leutinizing Hormone levels
( LH stimulâtes the testes to form testosterone)
What are the normal testosterone values
300-1000 ng/dL (348.3 ng/dl)
10-15 nMol/ L (12.1 nMol/L)
List 5 testosterone treatment options
Nebido (IM)
Testosterone implant
Depo- Testosterone
Androderm
AndroGel
Based on the IIEF-5 Questionnaire (International Index of Erectile Dysfunction- 5) state what each score represents
1-7: severe Erectile dysfunction
8-11: moderate Erectile dysfunction
12-16: mild-mod Erectile dysfunction
17-21: mild Erectile Dysfunction
22-25: No Erectile Dysfunction
What are the 7 main causes of Erectile Dysfunction
Vasculogenic
Neurogenic
Structural Abnormality
Drug Induced
Hormone related
Psychogenic
Trauma related
List some vasculogenic causes of Erectile Dysfunction
Cardiovascular Disease
Hyperlipidemia
Smoking
DM
List some neurogenic causes of Erectile Dysfunction
Central: degenerative disorders, spinal cord trauma, stroke, CNS tumour
Peripheral: DM 1/DM 2, polyneuropathy, chronic renal failure, surgery
List 3 anatomical/structural causes of Erectile dysfunction
Hypospadias, Micropenis, Peyronie’s disease
(Peyronie’s disease is a disorder in which scar link tissue, called plaque, forms under the skin of the penis)
List some hormonal causes of Erectile Dysfunction
Hypogonadism
Hyperprolactinaemia
Hyper/hypothyroidism
Hyper/hypocortisolism (Cushing’s )
List some drugs that may cause Erectile dysfunction
Antihypertensives(thiazide diuretics)
Antidepressants (selective serotonin re-uptake inhibitors)
Antipsychotics
Antiandrogens
Recreational Drugs
List 8 risk factors for Erectile Dysfunction
- Age
- Obesity
- Smoking
- sedentary lifestyle
- hypertension
- Diabetes
- hyperlipidemia
- Depression
Based on the Prostate Cancer Prevention Trial
Men with Erectile Dysfunction are how much more likely to experience cardiac event after 5yrs, than men without
45% more likely
Based on the Olmstead County Study:
Erectile Dysfunction was associated with what percentage higher risk of subsequent coronary artery disease at 10yrs
80% higher risk
What is used to assess patients or the population for early detection of Erectile Dysfunction?
Risk factor identification
Screening high risk populations
Diagnostic questionnaires
What laboratory tests are done when investigating Erectile Dysfunction
Fasting glucose
Lipid profile
Urinalysis
CBC
TSH
Serum Testosterone
Hat is the first line therapy for Erectile Dysfunction Management
PDE-5 inhibitors
(viagra)
Second line therapy for Erectile Dysfunction
Vacuum Erection Device
Intraurethral Pharmacotherapy
What is the third line of therapy for erectile dysfunction
Surgical prosthesis
List some side effects of PDE Inhibitors
Headaches
Flushing
Dyspepsia
Nasal Congestion
Visual Disturbances
What are the contraindications of PDE-5 inhibitors
Nitrate therapy
Alpha blocker
List 2 side effects of vacuum constriction devices for treating Erectile Dysfunction
Genital Ecchymosis
Penile “pivoting”
List one contraindication for Vacuum constriction devices
Sickle Cell Disease
What is the mechanism of action of Alpostadil? (Intraurethral Pharmacotherapy)
Induces corporal smooth muscle relaxant effects
List some side effects of Intraurethral Pharmacotherapy (Alprostadil)
Local pain
Urethral Bleeding
Dizziness
Hypotension
List one contraindication for Alprostadil
Priapism
What is the dosage of Alprostadil that is administered
5-10ug/ml
List some indications of Penile Prosthesis Surgery
- Major Penile Injury or Deformity
- Medical therapy contraindicated or unsuccessful
What are the indications for arterial revascularisation
Age <55
Non-smoker
Non-diabetic
No venous leakage
Radiographie confirmation of stenosis of internal pudendal artery
Pre mature Ejaculation can be
Lifelong (Primary)
Acquired (Secondary)
Transient
Chronic
Define Premature Ejaculation
A male sexual dysfunction that is typified by ejaculation that always or nearly always occurs prior to or within 1 min of vaginal penetration
What is the prevalence of premature ejaculation in the USA
21%
List 7 causes of premature ejaculation
Idiopathic
Psychological
Spinal Cord Injury
Inflammation
Medications
Anxiety
Associated Erectile Dysfunction
List four oral therapy option for treatment of premature ejaculation
Clomipramine
Fluoxetine
Paroxetine
Sertraline
What is the mechanism of Clomipramine
What is the mechanism of Fluoxetine, Paroxetine, Sertraline
Selective Serotonin Reuptake Inhibitor
List one topical therapy for treatment of Premature Ejaculation
Lidocaine/Prilocaine
