Men’s Health Flashcards
Main causes of erectile dysfunction
Biological
Psychological
Drug related
Biological ED
Vascular
Neurological
Anatomical
Hormonal
Psychological ED
Generalised and situational anxiety
Drug related ED
Many diabetes + vascular drugs
Most common cause of erectile dysfunction
Vasculogenic
Organic causes of of ED
Vasculogenic Neurogenic (central) Neurogenic (peripheral) Anatomical or structural Hormonal
Organic ED
Vasculogenic
cardiovascular disease (CVD), hypertension, hyperlipidaemia, diabetes mellitus, smoking, major pelvic surgery (radical prostatectomy, radiotherapy (pelvis or retroperitoneum)
Organic ED
Neurogenic (central)
degenerative disorders (such as multiple sclerosis, Parkinson’s disease, and multiple atrophy), stroke, spinal cord trauma or diseases, central nervous system tumours.
Organic ED
Neurogenjc (peripheral)
diabetes mellitus, chronic renal failure, polyneuropathy, major surgery of the pelvis or retroperitoneum, urethral surgery (for example urethral stricture and urethroplasty).
Organic ED
Anatomical or structural
Peyronie’s disease, penile cancer, prostate cancer, congenital curvature of the penis, micropenis, hypospadias, epispadias, phimosis.
Organic ED
Hormonal
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)
Psychogenic causes of ED
Generalised
Situational
Psychogenic ED
Gneralised
for example due to lack of arousability and disorders of sexual intimacy
Psychogenic ED
Situational
for example due to partner-or performance-related issues, stress, and psychiatric illness (including depression, anxiety, and schizophrenia)
Drugs associated with ED
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.
ED investigations
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
Diabetes HbA1C
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)
ED cardiovascular risk stratification
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
Priapism
Persistent erection
PDE-5 inhibitors
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
PDE-5 inhibitor available OTC
Sildenafil 50 mg tablets (Viagra Connect®) can be purchased over-the-counter from pharmacies and do not require a prescription
ED lifestyle advice
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
Function of PDE-5 inhibitors
they are not initiators of erection but require sexual stimulation in order to facilitate erection
ED definition
the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
Mechanism of PDE-5 inhibitors
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.
