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GU > Male Sexual Dysfunction - Exam 2 > Flashcards

Male Sexual Dysfunction - Exam 2 Flashcards

1
Q

What are the required components to male sexual function?

A

intact libido: need to have the sexual desire

ability to achieve and maintain penile erection

ejaculation

detumescence

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2
Q

____ causes an increase in male libido. _______ and ______ cause a decrease in male libido.

A

testosterone

hormonal or psych disorders and medication

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3
Q

What 3 things need to be intact in order for a male to achieve and maintain an erection?

A

Intact autonomic and somatic nerve supply

Functional musculature of corpora cavernosa and pelvic floor

Intact arterial blood flow to penis

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4
Q

What are the 2 normal erection pathways? What are the correlated spinal cord levels?

A

Central (psychogenic) - CNS to T11-L2

Peripheral (reflexogenic) - S2-S4

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5
Q

_____ start and maintain erection. While ______ promotes vascular relaxation

A

Neurotransmitters

nitric oxide (NO)

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6
Q

What needs to happen during the engorgement phase?

A

Relaxed smooth muscle in the corpora cavernosa and increased
blood flow to the penis

Trabecular smooth muscle compresses venous
return, promoting retention of blood and
maintaining erection

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7
Q

What is the normal ejaculation stimulated by?

A

sympathetic nervous system

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8
Q

What is the normal pathway for ejaculation?

A

Contraction of epididymis, vas deferens, seminal vesicles, prostate

Causes seminal fluid to enter the urethra → rhythmic contractions of bulbocavernosus and ischiocavernosus muscles → semen expulsion

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9
Q

What 3 things is detumescence regulated by? What is the end result?

A

norepinephrine, endothelin, smooth muscle contraction

Increases venous outflow and restores flaccid state

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10
Q

define erectile dysfunction. What is the general trend?

A

Consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance

Increasing incidence with age

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11
Q

T/F: ED is part of the natural age process and most men will experience it during their lifetime

A

FALSE!!!

ED is NOT part of the normal aging process

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12
Q

What are some associated factors for ED?

A

DM, obesity, BPH, HTN, CV disease, low HDL

smoking

local radiation or sx

Depression, anxiety, stress, anger

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13
Q

What are the big 3 causes of ED? These are present in ___ of cases

A

DM, atherosclerosis, medication

greater than 80% of cases

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14
Q

What are the 3 basic mechanisms of ED?

A

Failure to initiate erection (think psychogenic, endocrinologic, neurogenic)

Failure to fill penile tissue (think problem with arteries)

Failure to store adequate blood
volume in lacunar network (think venoocclusive dysfunction)

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15
Q

_____ is the MC organic cause of ED. Give some examples

A

Vasculogenic: disturbance of blood flow to or from penis

Atherosclerosis
traumatic arterial disease
anything that alters the veins (hypoxemia, hypercholesterolemia)

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16
Q

What are some neurogenic causes of ED?

A

trauma
MS
Peripheral neuropathy (especially with DM, alcoholism)

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17
Q

What are some endocrinologic reasons for ED?

A

Low testosterone
Increased prolactin - suppresses GnRH and testosterone

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18
Q

an increase in prolactin leads to a suppression of ______ and _____ resulting in _____

A

suppresses GnRH and testosterone

less libido

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19
Q

Why do DM and ED have such a strong correlation?

A

due to the negative impact on
Vascular disease
Neuropathy
Decreased NO synthesis

20
Q

Most pts with ED eventually develop a ________

A

psychogenic component

21
Q

What are some medication related causes of ED?

A

Thiazides, BBs, spironolactone

estrogens, GnRH agonists/antagonists (think prostate cancer treatments)

TCAs, SSRIs

H2 antagonists (Famotidine and Ranitidine)

22
Q

What are 3 special testing you can order to evaluate ED?

A

If no response to oral meds → direct injection of vasoactive meds
+ response = intact vasculature

If no response to injection → duplex US, cavernosography, arteriography

Penile nocturnal tumescence study

23
Q

What are the medication options for ED? What are the sx options?

A

Oral phosphodiesterase-5 (PDE-5) inhibitors
Injection therapies
Testosterone replacement therapy

Vacuum devices
Penile implants
Vascular surgery

24
Q

When would you prescribe testosterone as a tx option in ED?

A

Only beneficial in men with documented hypogonadism and low testosterone levels

25
Q

When is testosterone replacement therapy CI for prostate reasons?

A

Prostate cancer
Abnormal DRE
Severe LUTS with BPH
Unexplained PSA elevation

26
Q

What are the 2 first line options for testosterone replacement therapy?

A

Transdermal and IM injection

27
Q

How often does testosterone IM injection need to be given?

A

usually every 1-2 weeks

28
Q

What are some SE of testosterone replacement therapy? What is the highlighted one?

A

**Prostate growth factor - increased prostate CA risk, BPH exacerbation

OSA worsening
Erythrocytosis
Skin irritations
Spermatogenesis suppression,
Improved bone density
Virilization, increased libido, aggression

29
Q

What is the monitoring requirements for testosterone replacement therapy? What are the 3 DDIs?

A

measure level 2-3 months after starting tx and dose changes, then 6-12 months for maintenance

warfarin
GnRH agonists/antagonists
steroids

30
Q

What is the 1st line pharm therapy for ED? What is the MOA? Need to check _____ before prescribing

A

PDE-5 Inhibitors

inhibit PDE-5 enzyme which degrades cGMP, allowing sustained inflow of blood to penis

always check testosterone first before prescribing

31
Q

Which PDE-5 inhibitors need to be taken 1 hour prior to sexual activity and on an empty stomach? How long is the duration?

A

Sildenafil (Viagra)

Vardenafil (Levitra)

4 hours

32
Q

Which PDE-5 inhibitors need to be taken 30 minutes prior to sexual activity and with food? How long is the duration?

A

Avanafil (Stendra)

4 hours

33
Q

______ has the longest duration of up to 36 hours and can also be used daily tx of LUTS due to BPH and needs to be taken with food

A

Tadalafil (Cialis)

34
Q

What are the SE of PDE-5 Inhibitors?

A

headache, flushing, dyspepsia
Dizziness and hypotension

35
Q

**What is the MAJOR CI to PDE-5 inhibitors?

A

**patients taking nitrates in any form (including PRN NTG

DO NOT use PDE-5 inhibitors and nitroglycerin together

36
Q

What is the 2nd line tx for ED?

A

Vasoactive prostaglandin (alprostadil) injected directly into penile tissue

also comes in an urethral suppository but it is more expensive

37
Q

What is the pt education point for prostaglandin injections?

A

needs to be injected on the dorsolateral side of the penis

38
Q

What are some non-pharm tx options for ED? What are the major complication?

A

vacuum device

vasucular sx- expensive, low success rate, high risk of complication

penile prosthesis: major complication is they can erode

39
Q

What is the MC drug associated with a decreased libido?

A

SSRIs

40
Q

What are the 3 criteria to diagnosis premature ejaculation?

A

Brief ejaculatory latency
Loss of control to delay or stop ejaculation
Psychological distress in patient and/or partner

41
Q

What are the tx options for primary premature ejaculation?

A

behavioral modification, counseling, medications

SSRIs: paroxetine may be most effective

topical anesthetics

combination between pharm and counseling may be most effective

42
Q

What are some physical causes of delayed ejaculation?

A

blockage of spermatic ducts
injury to nervous system
ETOH
illicit drug use
psych medication

43
Q

What is retrograde ejaculation? What is another name for it?

A

Semen enters the bladder instead of emerging through the external urethral meatus during orgasm

dry orgasm

44
Q

When are retrograde ejaculations commonly seen?

A

seen after surgery for BPH
pelvic radiation
sympathetic denervation
alpha-blockers

45
Q

When should you tx retrograde ejaculation? What 3 medications are used?

A

only if fertility is desired

Imipramine, chlorpheniramine, pseudoephedrine

46
Q

Imipramine, chlorpheniramine, pseudoephedrine are commonly used in ______. How do they work?

A

retrograde ejaculation

Help keep bladder neck closed during ejaculation

47
Q
A

GU (13 decks)

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