Men's Health

Question 1

What are risk factors for erectile dysfunction?

Answer 1

Sedentary lifestyle
Obesity
Smoking
Metabolic syndrome
Hypercholesterolaemia

Question 2

What is metabolic syndrome?

Answer 2

A combination of diabetes, hypertension and obesity which puts you at higher risk of developing CVD

Question 3

What is the first line drug treatment for ED and how do they work?

Answer 3

Phosphodiesterase type 5- inhibitors
They increase the blood flow to the penis but don’t initiate an erection

Question 4

How should the first line treatment for ED be decided?

Answer 4

The frequency of intercourse and response to treatment

Question 5

What type of first line ED treatment should be used as short acting and occasional use?

Answer 5

Avanafil, sildenafil and vardenafil

Question 6

What type of first line ED treatment should be used as long acting and allows for frequent, spontaneous sex?

Answer 6

Tadalafil

Question 7

When would a patient with ED having treatment be classified as a non-responder?

Answer 7

A patient should receive 6 doses at the maximum dose before being classified as a non-responder

Question 8

What is the second line treatment for ED?

Answer 8

Intracavernosal- injection to the base of the penis, intraurethral or topical application of alprostadil (Caverject) is recommended as second line therapy under medical supervision

Question 9

What are the benefits of circumsicion?

Answer 9

Medical reasons:
Phimosis- the foreskin is too tight to be retracted
Recurrent balanitis (inflamed foreskin) which doesnt respond to treatment
Penile cancer

Question 10

What are the problems associated with circumsicion?

Answer 10

Rare- infections, damage to penis
Swelling is normal for 3 weeks, if more than refer to the GP

Question 11

What are the causes of male baldness?

Answer 11

Hair follicles are sensitive to dihydrotestosterone (DHT)

Question 12

What is the treatment for baldness?

Answer 12

Hair pieces, wigs, surgery
Drugs (not on NHS):
-Finasteride (Propecia)
-Minoxidil (Regaine)
Can get both by private Rx or Regaine by OTC

Question 13

What is the strength for the OTC hair treatment in different people?

Answer 13

Men- 5% lotion
Women- 2% lotion

Question 14

What are the cautions in the OTC hair treatment?

Answer 14

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

Question 15

How does the finasteride work as a treatment for hair loss?

Answer 15

Blocks the conversion of testosterone to dihydrotestosterone (5a reductase inhibitor)

Question 16

What are the statistics like for using finasteride in men for baldness?

Answer 16

New growth in 2/3 men, stops loss in 1/3 men
No effect in 1 in 100 men

Question 17

How long should men use finasteride for?

Answer 17

Continuous use for 4-6 months
Full effects in 2 years of treatment
Reverse 6-12 months after stopping

Question 18

What does the prostate gland do?

Answer 18

Stores and secretes semen/ protecting sperm

Question 19

State and describe diseases of the prostate:

Answer 19

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

Question 20

What are the symptoms of BPH?

Answer 20

Shouldn’t be dysuria
Impedes urine flow (dribbles)
-compresses urethra
-cause muscle contraction
-can cause complications of left untreated

Question 21

How is BPH diagnosed?

Answer 21

Prostate-specific antigen (PSA)
Transrectal ultrasound
International prostate symptom score (IPSS), rate of 0-7

Question 22

What is the IPSS?

Answer 22

Questions include: incomplete emptying, frequency, intermittency, urgency, weak stream, nocturia, straining
1-7= mild
8-19= moderate
20-35= severe

Question 23

What are the complications of BPH?

Answer 23

Acute urinary retention
UTIs
Bladder stones
Bladder damage
Kidney damage

Question 24

What is the non drug treatment for BPH?

Answer 24

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)

Question 25

What is the drug treatment for BPH?

Answer 25

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

Question 26

What are the cautions of phosphodiesterase 5 inhibitors?

Answer 26

Angina treatment as decreases BP

Question 27

When should it be a medical emergency over an erect penis when taking ED treatment?

Answer 27

Priapism- when there is an erection for more than 4 hours