Male sexual dysfunction

Question 1

what is sexual dysfunction (both M+W)

Answer 1

consistent failure to achieve sexual gratification

• > 50% of ppl encounter
• includes lack of interest

Question 2

what is lack of interest in sexual activity called?

Answer 2

Hypoactive Sexual Desire Disorder

Question 3

sexual dysfunctions with organic cause?

Answer 3

10-20%

• most have psychogenic cause.
• sometimes physiological/psychological co-exist.

Question 4

sexual dysfunction =/= sexual dissatisfaction

Answer 4

unhappy with relationship is different

Question 5

reasons for psychological basis for sex.dysfxn

Answer 5

• portrayals of sexual behaviour in pop media
• poor communication
• anxiety related to past sexual experience
• poor timing, too little foreplay, inability to relax, lack of trust, too little variety.

Question 6

how portrayal of sexual behaviour affects psychology

Answer 6

unrealistic, unattainable expectations of sexual encounters.

- fear of failure, rejection, performance anxiety

Question 7

how poor communication may affect psychology?

Answer 7

failure of partner to supply effective stimuli

Question 8

what is dyspareunia?

Answer 8

difficult or painful coitus

Question 9

why may dyspareunia occur in males?

Answer 9

• glans is hypersensitive (allergic to spermicides, urethritis, foreskin fused)
• accumulation of smegma in uncircumcised penic
• bend in penis
• scar tissue/infection in male sex accessory ducts/glands

Question 10

what is phimosis?

Answer 10

in infants + young men the foreskin is fused to the penis. damaging to retract foreskin before it naturally detaches.
- erection can be painful if there’s no natural detachment.

Question 11

what is smegma?

Answer 11

oils, debris. if accumulate in uncircumcised penis, may cause localized inflammation + increase sensitivity of glans causing sexual pain

Question 12

what is chordee?

Answer 12

exaggerated bend in the penis

- from fibrous/calcified tissue in top/sides of penis, usually from previous infection/injury.

Question 13

how penile fracture may cause chordee?

Answer 13

penis is erect + there’s sudden trauma, bend in penis causing tissue to rupture around the corpora cavernosa.

normal healing process may lead to fibrous tissue = chordee

Question 14

what is erectile dysfunction?

Answer 14

failure to gain or maintain an erection

- impotence is out of favour because implied lack of fertilizing capacity

Question 15

what are the two types of ED?

Answer 15

primary ED: never had an erection

secondary ED: has successfully attained/maintained erection in past, but no longer can at least 1/4 of the time
- affects 1/8 men

Question 16

causes of ED

Answer 16

60% are physical causes

• unusually low blood pressure in penis : increase arterial flow. need inflow to prevent venous outflow + maintain penile tumescence. = add AV shunt
• diabetes
• lower T levels (rare - may lower libido + erection capacity)
• abnormally low prolactin : maintains pulsatile release of GnRH - downstream effects. too high Pl may be bad too tho

Question 17

surgical treatment for ED

Answer 17

• penile implants for physical basis.
• • silicone implant that bends up or down.
• • saline tubes, bulb in scrotum. pump saline into tubes in penis = erect

Question 18

how to tell between psychological and physiological ED?

Answer 18

• determine if morning erection is present - normal erection every 30-90 mins. present = psych. absent = physiol
• can use pressure transducer to tell. if increase in pressure = erection
• psych conditions that activate symp - impair PNS and impair erection.

Question 19

treatment of ED (physiological)

Answer 19

• pharmacological: phosphodiesterase-5 inhibitors = inhibits breakdown of cGMP to make erection longer need to get erection, meds help maintain it
• viagra (sildenafil)

Question 20

process of erection on cell basis

Answer 20

• sexual stimulus
• suppress symp
• increase pns
  = NO and VIP released.
• NO increases cGMP
• cGMP elicits dilation + increases arterial inflow
• broken down by PGE5

Question 21

how viagra works?

Answer 21

if psychologically interested, and para increases + symp decreases, drug maintains erection.

Question 22

side effects of sildenafil

Answer 22

flushing, headache, nasal congestion

• not for males with cardiac problems
• other forms are longer lasting

Question 23

Alternative Treatment for ED, when PDE5 inhibitor doesnt work.
(5)

Answer 23

• uncomfy side effects, high cost, not allowed for cardiac dysfunction.
• intracavernous injections with vasogenic agents: trigger vasodilation PGE1 and CIP. unpleasant, may be complications

intraurethral pharmacotherapy : suppository in urethra

vascular surgery: if impaired arterial inflow or AV shunt - widen arteries that supply corpora cavernosa

vacuum erectile device: pump air out of cylinder, negative pressure draws blood into erectile tissue. provides tumescence + ring is at base to keep blood in. complications = excessive negative pressure can lead to rupture

• extracorporeal shock wave therapy: mictrotrauma supports release of endothelial NOS + growth factors. – restore circulation to corpora cavernosa. attain + maintain erection

Question 24

what is premature ejaculation

Answer 24

• subjective: what is too early?
• occurs at least 50% of the time before a partner reaches orgasm
• better definition = ejaculation before a mutually satisfying length of intercourse
• usually before or immediately after intromission
• most support for psychological bases
• • physiological bases: prostatitis/disease of NS

Question 25

what is prostatitis

Answer 25

infection of prostate gland of NS.

Question 26

learn “treatment”

Answer 26

training involved, when impending ejaculation - apply pressure to glans + head.

Question 27

ejaculatory incompetence

Answer 27

inability of male to ejaculate.

- never or in certain situations

Question 28

most common occurrence of ejaculatory incompetence

Answer 28

inability to ejaculate during penetrative sex

- may relate to psychological aspects

Question 29

retrograde ejaculation + coitus reservatus

Answer 29

re: ejaculate doesnt leave penis. enters bladder instead. bladder base sphincter should prevent this, but may occur if mechanism is impaired (diabetes, following prostate surgery)

CR: ejaculation is forced in retrograde direction. apply excessive pressure to glans + urethral opening. (learned method of contraception - not v effective * not considered incompetence bc forcing it + can be damaging over time)

Question 30

what is orgasmic dysfunction?

Answer 30

failure to achieve orgasm

• orgasm is cerebral. CNS controls. separate cerebral experience + neural mechanisms of ejaculation.
• most common sexual “dysfunction” in females.
• males can ejaculate in absence of orgasm : when fear or loss of erotic stimuli inhibit orgasm