Men’s Health

Question 1

Main causes of erectile dysfunction

Answer 1

Biological
Psychological
Drug related

Question 2

Biological ED

Answer 2

Vascular
Neurological
Anatomical
Hormonal

Question 3

Psychological ED

Answer 3

Generalised and situational anxiety

Question 4

Drug related ED

Answer 4

Many diabetes + vascular drugs

Question 5

Most common cause of erectile dysfunction

Answer 5

Vasculogenic

Question 6

Organic causes of of ED

Answer 6

Vasculogenic
Neurogenic (central)
Neurogenic (peripheral)
Anatomical or structural 
Hormonal

Question 7

Organic ED

Vasculogenic

Answer 7

cardiovascular disease (CVD), hypertension, hyperlipidaemia, diabetes mellitus, smoking, major pelvic surgery (radical prostatectomy, radiotherapy (pelvis or retroperitoneum)

Question 8

Organic ED

Neurogenic (central)

Answer 8

degenerative disorders (such as multiple sclerosis, Parkinson’s disease, and multiple atrophy), stroke, spinal cord trauma or diseases, central nervous system tumours.

Question 9

Organic ED

Neurogenjc (peripheral)

Answer 9

diabetes mellitus, chronic renal failure, polyneuropathy, major surgery of the pelvis or retroperitoneum, urethral surgery (for example urethral stricture and urethroplasty).

Question 10

Organic ED

Anatomical or structural

Answer 10

Peyronie’s disease, penile cancer, prostate cancer, congenital curvature of the penis, micropenis, hypospadias, epispadias, phimosis.

Question 11

Organic ED

Hormonal

Answer 11

hypogonadism, hyperprolactinaemia, hyperthyroidism, hypothyroidism, Cushing’s disease, panhypopituitarism and multiple endocrine disorders, hypopituitarism following traumatic brain injury (erectile dysfunction is estimated to occur in 15–25% of survivors of traumatic head injury and is often unrecognized)

Question 12

Psychogenic causes of ED

Answer 12

Generalised

Situational

Question 13

Psychogenic ED

Gneralised

Answer 13

for example due to lack of arousability and disorders of sexual intimacy

Question 14

Psychogenic ED

Situational

Answer 14

for example due to partner-or performance-related issues, stress, and psychiatric illness (including depression, anxiety, and schizophrenia)

Question 15

Drugs associated with ED

Answer 15

Antihypertensives — beta-blockers, verapamil, methyldopa, and clonidine.
Diuretics — spironolactone and thiazides.
Antidepressants — tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors.
Antiarrhythmic drugs — digoxin, amiodarone.
Antipsychotics — chlorpromazine, haloperidol.
Hormones and hormone-modifying drugs — antiandrogens (flutamide, cyproterone acetate), luteinising hormone releasing hormone agonists (leuprorelin, goserelin), corticosteroids, 5-alpha reductase inhibitors (for example finasteride).
Histamine (H2)-antagonists — cimetidine, ranitidine.
Recreational drugs — alcohol, heroin, cocaine, marijuana, methadone, synthetic drugs, anabolic steroids.

Question 16

ED investigations

Answer 16

HbA1c or fasting blood glucose and lipid profile
Lipid profile (+ BP and BMI to calculate 10 year CV risk)
Measure morning sample of total testosterone (also measure bioavailable or calculated-free testosterone to confirm total testosterone measurements if indicated)
(Pre-existing CVD - CV risk of sexual activity)
Other investigations based on hx + exam, eg PSA if abnormal DRE / aged over 50 / testosterone replacement being considered

Question 17

Diabetes HbA1C

Answer 17

HbA1c of 48 mmol/mol (6.5%) or more, or a fasting plasma glucose level of 7.0 mmol/L or greater (if the use of HbA1c is inappropriate)

Question 18

ED cardiovascular risk stratification

Answer 18

Low risk - no significant cardiac risk associated with sexual activity
Intermediate or indeterminate risk - men with an uncertain cardiac condition
High risk - cardiac condition that is sufficiently severe and/or unstable for sexual activity to carry a significant risk

Question 19

Priapism

Answer 19

Persistent erection

Question 20

PDE-5 inhibitors

Answer 20

Sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Spedra®)) are probably equally effective. The choice of treatment will depend on the frequency of intercourse, the man’s personal experience and preference, and cost

Question 21

PDE-5 inhibitor available OTC

Answer 21

Sildenafil 50 mg tablets (Viagra Connect®) can be purchased over-the-counter from pharmacies and do not require a prescription

Question 22

ED lifestyle advice

Answer 22

Lose weight (if overweight)
Stop smoking
Reduce alcohol consumption
Increase exercise
Continue with other prescribed meds for comorbidities (unless told otherwise)
Do not have sex if severe/unstable CVD that would make sex unsafe
If cycle more than 3 hours/week, trial without cycling
Do not take unlicensed herbal remedies for ED

Question 23

Function of PDE-5 inhibitors

Answer 23

they are not initiators of erection but require sexual stimulation in order to facilitate erection

Question 24

ED definition

Answer 24

the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

Question 25

Mechanism of PDE-5 inhibitors

Answer 25

Prolong the action of cGMP by inhibiting its degradation by the enzyme PDE5, which is found throughout the body. In the penis, PDE5 inhibitors potentiate the effects of cGMP to prolong erections and increase sexual satisfaction.