Mod 2.5 - Intro to sexual dysfunction

Question 1

What is sexual dysfunction defined as?

Answer 1

Consistent failure to achieve sexual gratification

• Includes lack of interest in sexual activity (Hypoactive sexual desire disorder HSDD)
  
  • Only considered a dysfunction of pt is distressed or their life is disrupted

Question 2

What are four psychological contributors for sexual dysfunction in men and women?

Answer 2

• Portrayals of sexual behaviour in popular media (porn)
  
  • 1/4 teenage boys suffer from erectile dysfunction because of porn
  • High, unrealistic, unattainable expectations of sexual interactions = judge self or partner
  • Fear of failure, rejection, performance anxiety
• Poor communication
• Anxiety related to past sexual experience
  
  • Pain, trauma, unpleasantness, guilt
• Poor timing
  
  • can also just be sexual dissatisfaction = NOT dysfunction

Question 3

What is dyspareunia?

Answer 3

Difficult or painful coitus

Question 4

What might cause dyspareunia in males?

Answer 4

Painful/difficult sex

• Glans may be hypersensitive
  
  • Urethritis
  • Allergic response to spermicides
  • Foreskin may be fused to glans (phimosis)
• Accumulation of smegma in uncircumcised penis
• Bend in penis (chordee)
• Scar tissue or infection in male sex accessory ducts or glands = painful ejaculation

Question 5

What is erectile dysfunction?

Answer 5

Failure to achieve and/or maintain an erection

Question 6

Two types of Erectile dysfunction:

Answer 6

1. Primary erectile dysfunction
   
   • pt has never had an erection
2. Secondary erectile dysfunction
   
   • more common
   • male has had erections but now fails to gain or maintain more than 25% of the time
   • affects 1/8 men at some point in their lives

Question 7

What proportion of erectile dysfunction cases have a physiological basis?

Answer 7

60%

Question 8

What physiological conditions might lead to erectile dysfunction?

Answer 8

Unusually low blood pressure in the penis - surgical correction

Diabetes (leads to vascular dysfunction)

Question 9

While men with erectile dysfunction do not typically have lower testosterone levels, why might androgen treatment help?

Answer 9

Androgen tx can increase libido and erection capacity

Question 10

How might psychology cause ED?

Answer 10

Erection requires parasympathetic dominance (point)

• psychological conditions that activate sympathetic system can impair/inhibit erection
  
  • fear, anxiety, sudden/intense stimuli
    
    • increase stress = increase sympathetic input

Question 11

What are possible treatments for erectile dysfunction?

Answer 11

• Phosphodiesterase 5 inhibitors
  
  • inhibit breakdown of cGMP
  • cGMP widens vessels and assists erection
• eg: Viagra (sildenafil)
  
  • only effective if male is psychologically interested in sexual activity

Question 12

Which patients shouldn’t use PDE5 inhibitors?

Answer 12

Any with cardiac dysfunction

Question 13

In cases where PDE5 (phosphodiesterase 5) treatments are ineffective or not possible, what are other tx options for ED?

Answer 13

• Intracavernous injections with vasogenic agents
  
  • prostaglandin E1, VIP
• Intraurethral pharmacotherapy
• Vascular surgery
• Vacuum erectile device
• Extracorporeal shock wave therapy
  
  • triggers neoangiogenesis to increase bloodflow
• Penile implants
  
  • mimic corpus cavernosa
  • pump with saline in scrotum