Men's Health

Question 1

Prevalence of erectile dysfunction

Answer 1

approx. 50% of men aged 40-70y

Question 2

Main factors contributing to erectile dysfunction

Answer 2

• Increasing age
• Diabetes
• Hypertension
• High cholesterol
• Vascular disease

Question 3

Medications that can cause erectile dysfunction

Answer 3

Antihypertensives (beta blockers, thiazides, clonidine)
Antidepressants (SSRIs, TCAs, MAOIs)
Lithium
Chemotherapy
Hormone therapy
Opiate analgesics

Question 4

Statistics of erectile dysfunction in men with diabetes

Answer 4

Prevalence 35-70%
Over 50% will develop within 10 years of diagnosis
Earlier development of ED compared to non-DM men
Increase risk 3x more than non DM men
Higher risk with increased duration of diabetes, poor glycaemic control and presence of other vascular complications of DM

Question 5

Suitable initial investigations in erectile dysfunction

Answer 5

Serum total testosterone (follow up with LH, prolactin and SHBG if abnormal)
Fasting BGL/HbA1c
Fasting lipids
PSA (if over 50y)

Question 6

First line management of erectile dysfunction

Answer 6

(optimise management of cause, smoking cessation, weight loss and exercise)
PDE-5 inhibitors (Sildenafil/viagra or tadalafil)
either PRN (on demand) or smaller dose daily

Question 7

Contraindications to use of PDE-5 inhibitors (viagra)

Answer 7

Recent MI
Concurrent nitrate medications
High risk of CVD

Question 8

2nd/3rd line management for erectile dysfunction

Answer 8

Intra-corporeal injections (alprostadil - vasodilation)
Vacuum Constriction Device
Intrapenile prostheses (if conservative management failed or contraindicated)