Male sexual dysfunction Flashcards
what is sexual dysfunction (both M+W)
consistent failure to achieve sexual gratification
- > 50% of ppl encounter
- includes lack of interest
what is lack of interest in sexual activity called?
Hypoactive Sexual Desire Disorder
sexual dysfunctions with organic cause?
10-20%
- most have psychogenic cause.
- sometimes physiological/psychological co-exist.
sexual dysfunction =/= sexual dissatisfaction
unhappy with relationship is different
reasons for psychological basis for sex.dysfxn
- 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.
how portrayal of sexual behaviour affects psychology
unrealistic, unattainable expectations of sexual encounters.
- fear of failure, rejection, performance anxiety
how poor communication may affect psychology?
failure of partner to supply effective stimuli
what is dyspareunia?
difficult or painful coitus
why may dyspareunia occur in males?
- 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
what is phimosis?
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.
what is smegma?
oils, debris. if accumulate in uncircumcised penis, may cause localized inflammation + increase sensitivity of glans causing sexual pain
what is chordee?
exaggerated bend in the penis
- from fibrous/calcified tissue in top/sides of penis, usually from previous infection/injury.
how penile fracture may cause chordee?
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
what is erectile dysfunction?
failure to gain or maintain an erection
- impotence is out of favour because implied lack of fertilizing capacity
what are the two types of ED?
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
causes of ED
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
surgical treatment for ED
- penile implants for physical basis.
- silicone implant that bends up or down.
- saline tubes, bulb in scrotum. pump saline into tubes in penis = erect
how to tell between psychological and physiological ED?
- 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.
treatment of ED (physiological)
- pharmacological: phosphodiesterase-5 inhibitors = inhibits breakdown of cGMP to make erection longer need to get erection, meds help maintain it
- viagra (sildenafil)
process of erection on cell basis
- sexual stimulus
- suppress symp
- increase pns
= NO and VIP released. - NO increases cGMP
- cGMP elicits dilation + increases arterial inflow
- broken down by PGE5
how viagra works?
if psychologically interested, and para increases + symp decreases, drug maintains erection.
side effects of sildenafil
flushing, headache, nasal congestion
- not for males with cardiac problems
- other forms are longer lasting
Alternative Treatment for ED, when PDE5 inhibitor doesnt work.
(5)
- 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
what is premature ejaculation
- 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
