Men's Health_ Erectile Dysfunction

Question 1

Male sexual dysfunction can be grouped into which categories?

Answer 1

• Erectile dysfunction (ED)
• decreased libido
• ejaculation problems
  
  • retrograde ejaculation and
  • premature ejaculation

Question 2

Defination of ED

Answer 2

The inability to initiate or maintain an erection sufficient for satisfactory sexual performance

Question 3

What is the prevalence of ED?

Answer 3

• 1/3 of men age 40
• 2/3 of men age 70

Question 4

What are the common etiologies of ED?

Answer 4

• Psychologic (anxiety, depression, life stressors)
• neurologic (diabetes, status postprostatectomy)
• endocrine (hypogonadism, hyperprolactinemia, thyroid disease)
• vascular (inadequate arterial flow into the corpora cavernosa from atherosclerosis)
• anatomic (Peyronie disease leading to fibrous plaques involving the corpora cavernosa)

Question 5

What medications can cause ED?

Answer 5

• Antihypertensives
  
  • thiazides
  • spironolactone
  • beta-blockers
  • alpha-blockers)
• psychiatric medications
  
  • tri-cyclic antidepressants
  • monoamine oxidase inhibitors
  • selective serotonin reuptake inhibitors)
• alcohol
• H2 antagonists (due to antiandrogenic properties)

Question 6

What labs can be ordered to evaluate ED?

Answer 6

• Serum total testosterone (drawn at the 8 AM testosterone peak to evaluate for hypogonadism)
• prolactin (elevated prolactin from a prolactinoma inhibits gonadotropin-releasing hormone [GnRH])
• thyroid stimulation hormone (both hypo- and hyperthyroidism can contribute to ED)
• glucose and cholesterol (diabetes and hyperlipidemia are risk factors for arterial disease)

Question 7

What are the first-line treatments for ED?

Answer 7

• Phosphodiesterase-5 (PDE-5) inhibitors
• psychotherapy (for anxiety or depression)
• testosterone replacement (for hypogonadism)

Question 8

How do PDE-5 inhibitors work?

Answer 8

• During an erection, intracavernosal cyclic GMP causes vasodilation and is broken down by PDE-5.
• PDE-5 inhibitors prevent the breakdown of cGMP.

Question 9

What are the side effects of PDE-5 inhibitors?

Answer 9

• vasodialation can case
  
  • severe hypotension (when used with nitrates)
  • Flushing
  • Rhinitis
  • Lightheadedness

Question 10

What percentage of patients taking PDE-5 inhibitors will have priapism?

Answer 10

• less than 2%
• Patients with erections lasting more than 4hours should seek immediated medical assistance

Question 11

What is the duration of action of PDE-5 inhibitors?

Answer 11

• Sildenafil and vardenafil start working 30 minutes after ingestion and last for 4 hours.
  
  • Absorption of these two medications is decreased with high fat meals.
• Tadalafil starts working 16 minutes after ingestion and lasts for 36 hours.

Question 12

What treatments can be tried after failure of first-line treatments for ED?

Answer 12

• Intrapenile injections
• intraurethral alprostadil
• vacuum pumps
• semirigid or inflatable prostheses

Question 13

What treatment can be offered to men with ED secondary to hypogonadism?

Answer 13

• Testosterone replacement (commonly delivered using a patch or gel)

Question 14

What are the side effects of testosterone replacement?

Answer 14

• Increased prostate volume
• erythrocytosis
• skin irritation from transdermal testosterone
• increased sleep apnea symptoms
• hyperlipidemia