Male Sexual Dysfunction 2

Question 1

What are the phases of an erection?

Answer 1

• Flaccid Phase: Penis with minimal venous and arterial blood flow present. Blood gas levels are similar to venous levels.
• Latent Phase: There is an increase in flow in the internal pudendal artery during the systolic and diastolic phases. The intracavernosal pressure is unchanged, but the penis has some elongation.
• Tumescent Phase: The intracavernosal pressure rises until a full erection is obtained. Increased blood flow in the cavernosal artery
• Full Erection Phase: Pressure rises to 80-90% of systolic blood pressure. Blood still flowing in the cavernosal artery. Compression of the venous channels that drain the penis begins.
• Skeletal (Rigid) Erection Phase: With contraction of the ischiocavernous muscle, the intracavernosal pressure now rises above systolic blood pressure. Almost no blood flows in the cavernosal artery. This phase is of short duration, so ischemic injury does not occur.
• Detumescent Phase: Resolution of the erection occurs, typically after ejaculation or after exposure to erotic stimuli has ceased. The cavernosal smooth muscle contracts. Sympathetic tone increases. Arterial inflow decreases. Blood within the sinusoidal spaces drains from the penis and the compressed venous drainage channels reopen. The penis length and girth return to flaccid levels.

Question 2

What were the key findings of the Massachusetts Male Aging Study?

Answer 2

• Community Based Survey (Men 40-70 yo)
• 52% of respondents acknowledge ED
  
  • 17% mild ED
  • 25% moderate ED
  • 10% complete ED
• With age came an increase in the severity of ED
• Over 70% of men > 65 yo reported being sexually active

Question 3

What are the risk factors for erectile dysfunction?

Answer 3

• Hypertension
• Hyperlipidemia
• Diabetes Mellitus
• Heart Disease
• Smoking History (Dose Dependent Relationship)
• Radiation Treatment for Pelvic Malignancy (including prostate cancer)
• Surgical Treatment for Pelvic Malignancy (including prostate cancer)

Question 4

What are the three major causes of erectile dysfunction?

Answer 4

• Psychogenic causes
• Organic causes
• Mixed organic and psychogenic causes

Question 5

What are the major types of psychogenic causes of erectile dysfunction?

Answer 5

• Generalized Type
• Situational Type

Question 6

What are some generalized type psychogenic causes of male orgasmic dysfunction?

Answer 6

• Generalized unresponsiveness
  
  • primary lack of sexual arousability
  • age associated decline in sexual arousability
• Generalized inhibition
  
  • chronic disorder of sexual intimacy

Question 7

What are some situational type psycogenic causes of erectile dysfunction?

Answer 7

• Partner Related
  
  • lack of arousability in a specific relationship
  • lack of arousability due to preference of sexual object
  • high central inhibition (i.e. partner conflict, threat)
• Performance Related
  
  • associated with other sexual dysfunction
  • situational performance anxiety
• Psychological distress or adjustment related
  
  • associated with negative mood state (i.e. anxiety, depression)
  • associated with major life stress (i.e. partner’s death)

Question 8

What are the major subtypes of organic causes of erectile dysfunction?

Answer 8

• Neurogenic
• Hormonal
• Arterial
• Cavernosal
• Drug induced

Question 9

What are some neurogenic causes of erectile dysfunction?

Answer 9

• Central
  
  • dementia
  • stroke
  • Parkinson’s disease
  • brain tumors
  • trauma
  • spinal cord injury (nature, location, extent of injury)
• Peripheral
  
  • peripheral nerve injury (pudendal, cavernous)
  • radical prostatectomy
  • abdominal-perineal resection
  • external sphincterotomy
  • peripheral neuropathy
  • diabetes mellitus
  • alcohol abuse

Question 10

What are some hormonal causes of erectile dysfunction?

Answer 10

• Hypogonadism (low testosterone)
  
  • aging related
  • hypothalamic and pituitary tumors
  • anti-androgen therapy
  • orchiectomy (surgical removal of testicle)
• Hyperprolactinemia
• Cushing’s syndrome
• Addison’s disease
• Hypothyroidism
• Hyperthyroidism

Question 11

What are some arterial causes of erectile dysfunction?

Answer 11

• Congenital
• Trauma
• Hypogastric-cavernosal-helicine arterial network
• Long distance cycling risk factor
• Generalized systemic disease
• Incidence/age of onset for ED/CAD similar
• Common risk factors for ED/CAD

Question 12

What are the cavernosal causes of erectile dysfunction?

Answer 12

• Failure of penile venous occlusion during an erection
• Seen most commonly in setting of:
  
  • Peyronies disease
  • penile fracture
  • diabetes mellitus

Question 13

What are some drug induced causes of erectile dysfunction?

Answer 13

• Drugs that disrupt central neurotransmitters
  
  • antipsychotics
  • antidepressants
  • centrally acting antihypertensive agents
• Beta adrenergic blocking drugs
• Thiazide diuretics
• Opiates
• Antiretroviral drugs
• Histamine H2 receptor antagonists
  
  • Cimetidine
• Antiandrogen agents
  
  • Finasteride,
  • Estrogens
  • Ketoconazole,
  • LHRH agonists