male sexual dysfunction Flashcards
Dx classification: sexual desire disorder- what is the usual presentation?
Male Hypogonadism
Dx classification: sexual arousal disorder- what is the usual presentation?
Erectile Dysfunction
Dx classification: orgasmic disorder- what is the usual presentation?
Premature Ejaculation (sometimes anorgasmia)
Dx classification: sexual pain disorder- what is the usual presentation?
dyspareunia or sexual dysfunction due to medical condition
sexual dysfunction: an all or nothing problem?
NO …Rarely purely organic or purely psychogenic
Comorbidity is common
Comprised of complex interactions
6 changes with aging
- Decreased frequency of activity
- Decreased arousal to psychological stimuli
- Decreased tactile sensitivity of penis
- Decreased rates of premature ejaculation
- Increased refractory period after orgasm (before they can be excited again)
- Increased rates of erectile dysfunction
setting the stage to talk about sexual dysfunction: introduce and ______
normalize … use relationship builiding skills
two things to do before beginning physical exam
Chaperone in exam room often advisable
Always wear gloves (!)
Patient may be either supine or standing, but check for ________ or _______ when patient stands
hernias or varicoceles
define erectile dysfunction
The inability to achieve or maintain an erection sufficient for the completion of sexual intercourse
erectile dysfunction is estimated in 10-15% of men, up to ____% at age 40, ____% at age 70. what is the etiology?
Estimated in 10-15% of men
Up to 40% at age 40
70% at age 70
Multifactorial in etiology
what is the ANS involved with getting an erection?
Parasympathetic: engorgement
Sympathetic: detumescence - blood drains out
how do you identify erectile dysfunction? 3 parts
- Sexual, Medical, and Psychosocial Hx
- Physical Examination- including looking at testicular size (sign of hypogonadism)
- Laboratory tests - not many. except common sign of DM and athresclerosis is erectile dysfunction
4 physical causes of erectile dysfunction (maybe weeds)
- Peripheral Vascular Disease
- Diabetes (neuropathy)
- Consumption of alcohol, tobacco, medications, and recreational drugs
- Hormonal or endocrine abnormalities
two medications who most prominently cause erectile dysfunction ?
- anti-depressants (SSRIs usually)
2. 1st gen antihistamine (anticholinergic)- Parasympathetic blocked
4 other medications that can cause erectile dysfunction (maybe weeds) (6)
- Antihypertensives (Thiazides, B-blockers)
- H2 Blockers
- Decongestants (sympathomimetic)
- Anticonvulsants and mood stabilizers (carbamazepine, lithium)
- Antipsychotics
- “Recreational” (Ethanol, Cocaine, Marijuana)
if you can’t modify reversible causes, what is your first line to treat erectile dysfunction?
Oral Erectogenic Agents (viagra)
what are the oral erectogenic agents ? what kind of inhibitors are they?
PDE -5 inhibitors ... sildenafil (Viagra®) vardenafil (Levitra®) tadalafil (Cialis®) avanafil (Stendra®)
2nd line option for erectile dysfunction ?
vaccuum constriction devices
who often gets vacuumm constriction devices? why?
Extremely popular with the VAMC crowd (covered by the Veterans Assosciation)
simple, reliable
Economical ($100-250)
Few Adverse Effects
2 other second/third line therapies for erectile dysfunction ?
- Intraurethral Alprostadil (prostaglandin E1)
2. Intracavernosal Self-Injection
third line surgical option for erectile dysfunction ?
Surgical Prosthesis:remove corpus cavernosum and insert balloon, inflate with saline when you want an erection
- pump into scrotum
define premature ejaculation
“Ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners”
-American Urological Association
____- ____% of Men experience premature ejaculation, but it tends to improve with ____.
20-30 %
age
avg time before ejaculation
2min
psychosocial issues that coincide with premature ejaculation ? (7)
- Lack of sexual knowledge
- Sexual inexperience
- Unrealistic expectations
- Performance anxiety
- Change of health status of either partner
- Low arousal levels/desire
- “Bad Habits” (e.g. excessive masturbation)
3 oral agents to treat premature ejaculation
- Tricyclics (clomipramine/Anafranil)
25-50 mg 12 hours prior to intercourse - SSRIs (fluoxitine/Prozac®, sertraline/Zoloft® and paroxetine/Paxil®)
- Alpha-blockers (terazosine/Hytrin)
2 topical agents for premature ejaculation
- lidocaine/prilocaine (EMLA)
2. Condoms
if youre using lidocaine for premature ejaculation, when do you take it?
30 minutes prior to intercourse
4 options for nonpharmacologic txt for premature ejaculation ?
- Start-stop technique (weeks to months)
- Squeeze-stop technique
- Kegel Exercises (3-6 months)
- Psychological/Sexual Therapy
inhibited sexual desire is more common in women or men?
women
those with low libido and low interest don’t respond well to________ _________
psychological intervention
what is the ADAM questionnaire? why do we use it?
set of 10 Qs to determine androgen deficiency. Testosterone levels naturally go up and down throughout the day.. so it’s hard to test for a person’s baseline level.
how are ADAM scores determined?
Positive Screen = Answering “Yes” to # 1 or 7
or 3 other questions
what are the 10 ADAM questions?
- Decreased Libido?
- Lack of Energy?
- Decrease in Strength/Endurance?
- Lost Height?
- Decreased Enjoyment of Life?
- Sad/Grumpy?
- Erections Less Strong?
- Recent Deterioration in Ability to Play Sports?
- Falling Asleep After Dinner?
- Deterioration in Work Performance?
low testosterone with no symptoms. does this mean they have an androgen deficiency disorder?
low testosterone levels without symptoms mean NOTHING. “Low T” This is a ploy by companies who sell testosterone replacement. so DON’T txt someone just for low testosterone levels. it can be HARMFUL
what is the most consistent physical finding for low testosterone levels ?
small testicles
what is andropause?
as men age, testosterone naturally decreases
dyspareunia in men, is this common or rare?
rare
what is the most common cause of dyspareunia in men?
Peyronie’s Disease
ED rates ____ in pts living with HIV and on ART.
ED rates ~double in Pts living with HIV, on ART (not sure why..)
