Men's Health

Question 1

Describe the physiologic process of an erection?

Answer 1

T11-L2 central sensual input (thoracolumbar erection center) - redirect blood to the copora cavernosa. Reflex arc originates S2-S4 . Reflex vs psychogenic erections.
Pressure increases - prevents outflow from veins, nitric oxide neurotransmitter relaxing trabeculae and maximising flow.
Metabolism of cBMP - via 5 cGMP phosphodiesterase causes detumescence

Testosterone plays a role - LH activates Leydig cells for testosterone. Enhances libido and NOS levels.

Question 2

What are some risk factors for ED?

Answer 2

• Age
• Depression
• Obesity
• DM
• Dyslipidemia
• HTN
• Neurovascular disease
• OSA
• Smoking
• Medications
  
  • Antihypertensives
  • Anticholinergics
  • Antidepressants
  • Antipsychotics

Question 3

What are some treatments for ED?

Answer 3

1. Counselling
2. Nitrates = e.g. sildenafil 1h prior to sexual intercourse
   CI GTN SE facial flushing and headache
3. Intracavernosal = e.g. alprostadil
   SE local pain, fibrosis, priapism
4. Vacuum erection devices/implants

Question 4

When examining for ED what do you look for?

Answer 4

1. Femoral and peripheral pulses
   
   2. Femoral bruits
   3. Penile plaques (Peyronie’s disease)
   4. Loss of lack of normal hair, gynecomastia, small testes
   5. Cremasteric reflex (thoracolumbar erection center integrity)
   6. Visual field defects (pituitary tumours)

Question 5

What are some Ix that you would perform for ED?

Answer 5

1. HbA1C and fasting glucose
   
   2. FBC
   3. Metabolic profile for LFT, kidney function, TSH and lipid profile (CVD risk)
      
      4. Total serum testosterone, (if low measure prolactin too)