Men's Health Flashcards
What are risk factors for erectile dysfunction?
Sedentary lifestyle
Obesity
Smoking
Metabolic syndrome
Hypercholesterolaemia
What is metabolic syndrome?
A combination of diabetes, hypertension and obesity which puts you at higher risk of developing CVD
What is the first line drug treatment for ED and how do they work?
Phosphodiesterase type 5- inhibitors
They increase the blood flow to the penis but don’t initiate an erection
How should the first line treatment for ED be decided?
The frequency of intercourse and response to treatment
What type of first line ED treatment should be used as short acting and occasional use?
Avanafil, sildenafil and vardenafil
What type of first line ED treatment should be used as long acting and allows for frequent, spontaneous sex?
Tadalafil
When would a patient with ED having treatment be classified as a non-responder?
A patient should receive 6 doses at the maximum dose before being classified as a non-responder
What is the second line treatment for ED?
Intracavernosal- injection to the base of the penis, intraurethral or topical application of alprostadil (Caverject) is recommended as second line therapy under medical supervision
What are the benefits of circumsicion?
Medical reasons:
Phimosis- the foreskin is too tight to be retracted
Recurrent balanitis (inflamed foreskin) which doesnt respond to treatment
Penile cancer
What are the problems associated with circumsicion?
Rare- infections, damage to penis
Swelling is normal for 3 weeks, if more than refer to the GP
What are the causes of male baldness?
Hair follicles are sensitive to dihydrotestosterone (DHT)
What is the treatment for baldness?
Hair pieces, wigs, surgery
Drugs (not on NHS):
-Finasteride (Propecia)
-Minoxidil (Regaine)
Can get both by private Rx or Regaine by OTC
What is the strength for the OTC hair treatment in different people?
Men- 5% lotion
Women- 2% lotion
What are the cautions in the OTC hair treatment?
Caution in sunburn and scalp psoriasis
Can cause a decrease in BP
A long term treatment as if you stop, any hair grown will go within 2-3 months
How does the finasteride work as a treatment for hair loss?
Blocks the conversion of testosterone to dihydrotestosterone (5a reductase inhibitor)
What are the statistics like for using finasteride in men for baldness?
New growth in 2/3 men, stops loss in 1/3 men
No effect in 1 in 100 men
How long should men use finasteride for?
Continuous use for 4-6 months
Full effects in 2 years of treatment
Reverse 6-12 months after stopping
What does the prostate gland do?
Stores and secretes semen/ protecting sperm
State and describe diseases of the prostate:
Prostate cancer- malignant growth of prostate cells, localised and may spread, rare in men under 50
Benign prostatic hyperplasia- non malignant, increase in size of the prostate with age, rare in men under 50
Prostatitis- inflammation of the prostate, can occur in men of any age
What are the symptoms of BPH?
Shouldn’t be dysuria
Impedes urine flow (dribbles)
-compresses urethra
-cause muscle contraction
-can cause complications of left untreated
How is BPH diagnosed?
Prostate-specific antigen (PSA)
Transrectal ultrasound
International prostate symptom score (IPSS), rate of 0-7
What is the IPSS?
Questions include: incomplete emptying, frequency, intermittency, urgency, weak stream, nocturia, straining
1-7= mild
8-19= moderate
20-35= severe
What are the complications of BPH?
Acute urinary retention
UTIs
Bladder stones
Bladder damage
Kidney damage
What is the non drug treatment for BPH?
Watchful waiting if symptoms are mild and have ruled out anything else
Surgery- transurethral incision of the prostate (TUIP)
-transurethral resection of the prostate (TURP)
What is the drug treatment for BPH?
Alpha blockers e.g tamsulosin (flowmax) OTC- relaxes bladder mucles, offer to men with moderate to severe symptoms
Finasteride (proscar), reduces prostate size, offer if more then 30g and at high risk of progression and severe symptoms
What are the cautions of phosphodiesterase 5 inhibitors?
Angina treatment as decreases BP
When should it be a medical emergency over an erect penis when taking ED treatment?
Priapism- when there is an erection for more than 4 hours
