Module 3.2 (ED) Flashcards
What is definition for ED?
80% of causes of erectile dysfunction have and organic cause (neurovascular disease, diabetes or medication)
Fewer than 20% of cases are due to primary psychogenic erectile failure → clustered in men at the beginning of their sexual experience
Persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance
> no universal criteria
> occasional episodes ok
> recurrence/persistence (>3 months) = reasonable guide
What is ED associated with?
Cardiovascular disease and diabetes
> “Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors”
What is the mechanism of an erection?
- Sexual arousal
- Release of NO from neurone synapses in corpus carvenosum of penis
- Accumulation of cyclic guanosine monophosphate (cGMP)
- Smooth muscle relaxation
- Inflow of blood to the corpus carvenosum
- Erection
What are some vascular causes of ED?
- Atherosclerosis, PVD, MI
- Hypertension, dyslipidaemia
- Vascular injury
- Blood vessel and nerve trauma
What systemic diseases can cause ED?
- Respiratory –> COPD and sleep apnoea
- Endocrine –> hyper/hypothyroidism, hypogonadism, diabetes mellitus
- Renal/liver failure
- Cancer
’
What neurological conditions causes ED?
- Epilepsy, stroke
- MS, Guillain-Barre syndrome
- Alzheimers disease
What psychiatric conditions cause ED?
Depression
Performance anxiety
PTSD
> surgery, medications, drug/alcohol alll can contribute also
What are some risk factors for ED? Include a comprehensive list of medications that do also please.
Increasing age
Some clinical conditions
Smoking
Medications
- Antihypertensives (thiazide diruetics, spironolactone, beta blockers)
- Antidepressants (SSRIs)
- Antipsychotics (olanzapine and risperidone)
- H2As (nizatidine, famotidine…)
- 5-alpha-reductase inhibitors = reduce testosterone (finasteride and dutasteride)
- Gemfibrozil
- Methadone
- Hormones
- Cytotoxic agents
- Immunomodulators
- Anticholinergic agents
- Opioids
- Recreational drugs
Furosemide may be contributing to LUTS -
> 5 in 1000 people taking beta blockers had issues with erectile dysfunction
> NICE guidelines suggest consider offering a late afternoon loop diuretic to men with nocturnal polyuria. This presumably will assist in more complete bladder emptying and reduce nocturnal symptoms.
- Diuretic in afternoon more effectively empties the bladder in someone with BPH
What need to assess and test patient for before commencing pharmacotherapy? What is sufficient cardiac fitness for sexual activity?
Sufficient cardiac fitness for sexual activity = climb 20 stairs in 15 seconds
rest of the answer see attached image
What is an example of a questionaire to assess ED? What score is used?
5-item IIEF5 score
<22: ED
17-21: Mild ED
8-16: Moderate ED (mild to moderate 12-16)
<8: Severe ED
How is ejaculation mediated? What are the 2 phases?
Mediated by autonomous nervous system
2 phases
- Emission
- Expulsion
What is the pathogenesis of premature ejacualtion?
- Psychorelational
- Neurobiological
- Urological
- Hormonal
- Andrological
How is premature ejaculation defined?
Persistent or recurrent ejaculation before, during or shortly after penetration
> intravaginal ejucalatory time of <2 minutes
2 types of premature ejaculation?
Primary: lifelong (from beginning of sexual experience); never had control over ejaculation
Secondary: acquired, i.e. secondary to other factors (situitational ED)
What is anejaculation and retrograde ejaculation caused by?
Interruption of neural pathways of ejaculation
> autonomic neuropathies (especially in long-term diabetes)
