Sexual Dysfunction And Reproductive Disorders Flashcards
What is causing ED if it is random and infrequent
Psychological
Depress, anxiety, stress
How to avoid ED long term
Frequent erections promote subsequent erectile potency
frequent ejaculations improve sperm quality and decrease risks of prostate cancer
When is ED more common in men
Sex less than once a week
% of males confident in erection in 40s and at old ages
60% in 40s
7% at old age
Changes in sperm with age. Provide age range
Decrease in semen volume (3-22%)
Impaired sperm motility (3-35%)
Impaired sperm morphology (4-18%)
Due in part to decreasing T with age
Start age 30-50 yrs
Medical evaluation of ED
Libido- sex drive (low T, mental health, steroid use)
Injury- nerve
Medication- depressant (benzodiazepine)
Present medical condition- atherosclerosis, cancer
Prostate- cancer
Erection at all- still have nocturnal ejaculation (wet dreams)
Nocturnal or morning erection
Incontinence- lack of bladder control
Stress/depression- mental health
Different interventions to stop ED
Surgery- vascular reconstruction, penile prosthesis/implant (penis pump)
Devices- pump, ring
Behavioural therapy
Reversible causes- medications, smoking (cannabis, cocaine), alcohol
Pharmacology- PDE5 inhibitor (Sildenafil), injection therapy (prostaglandins), MUSE (suppository with prostaglandins for urethra), testosterone (controversial- inhibit HPA axis)
Factors causing erectile dysfunction
Psychogenic- traumatic experiences, depression, anxiety, major life events, relationship problems
Vascular/endothelial- atherosclerosis, hypertension, dyslipidemia, smoking
Neurological- CNS= SCI, MS, brain injury. PNS= neuropathy, diabetes. Efferent= pelvic surgery
Penile factors- cavernous fibrosis (replace VSM with harder, not able to relax/constrict the same), age related changes
Endocrine- diabetes (lead to peripheral vascular damage), hypogonadism
Drug induced- recreational, psychotropic, anti-HTN, anti-androgenic
General health- CVD, aging, obesity, sedentary
What is the first line of treatment for ED
PDE5 inhibitors
Three types of ejaculatory dysfunction
Premature/early ejaculation (75%)
- 1 min ejaculation after sustained penetration
- associated with ED (lose erection quick because ejaculate fast)
- to fix: sex therapy, PDE5 inhibitors, local anaesthetic cream with condom (lidocaine), more practice
Delayed ejaculation/anejaculation
- caused by nerve damage (para or symp)
- associated with pudendal neuropathy
- to fix: sex therapy (if mental), correct reversible cause partaking in, drugs (vasodiazepam)
Retrograde ejaculation
- dry orgasm caused by impairments to bladder sphincter (normally will contract during arousal and ejaculation)
- associated with TURP, diabetic neuropathy, SCI
- sperm can be retrieved for fertility treatments (IVF)
What is cryptorchidism who does it effect
When testes don’t descend
3% full term babies
30% premature babies
Most will descend in first month
If testicles don’t descend on there own, what age should surgery be done? What are the associated risks with this condition
Cryptorchidism
Surgery early- 1 year
Strong benefit before 13 years
Associated with increased risk of testicular cancer (4-40 fold) and infertility (10-40%)
D2:D4 ratio in cryptorchidism
D2<D4 (lower ratio)
Higher T in utero
This high T seems to play a role in hindering development, maybe causing a decreased sensitivity to T
What maternal exposure can play a role in cryptorchidism
Endocrine disruptors (estrogenic or anti-androgenic)
- PDBE is an endocrine disrupter in flame retardant chemicals
(Newborn babies tested for endocrine disruptors)
What is PDBE
Endocrine disruptor in flame retardant chemicals (textiles, water bottles, plastics)
How are ovarian cysts caused
Lack of follicular development
Anovulation- egg doesn’t release from ovary
What is PCOS
Polycystic ovarian syndrome
Frequent large cysts in ovaries
High androgen
Anovulation
Amenorrhea- no period
What condition can cause an individual to be more susceptible to PCOS. Briefly explain pathway
Diabetes
Hyperinsulinaemia
- increase androgen precursors and frequency GnRH pulses
- GnRH increases LH and decreases FSH while androgen produce excessive testosterone
- LH - theca cells - testosterone
- FSH - granulosa cells - follicles fail to mature “cysts”
- both create diff symptoms
- testosterone converted to estrogen via aromatase - negative feedback on FSH by estrogen
- adiposity is a source of aromatase and is insulin resistant
How to stop PCOS from happening
First- Exercise and weight reduction (adiposity - aromatase)
On insulin ppl
- OCP (oral contraceptive pills) increase SHBP (sex hormone binding protein) - inhibit testosterone
- clomid inhibit estrogen negative feedback of FSH
- metformin increase insulin sensitivity therefore less resistance
What is primary vs secondary amenorrhea
Primary- absence of menstruation by 16
- Turner’s syndrome
- aromatase deficiency
Secondary- more than three months without menstruation
- hormonal imbalance, premature menopause
- pregnancy, lactation
- PCOS
- low weight, eating disorder, high athleticism
What issues does an individual with relative energy deficiency in sports (RED-S) aka Athlete Triad have
- amenorrhea (if female)
- low adiposity, low energy available- possible eating disorder
- lean body mass, low weight
- absence of E2 which is needed for bone growth and maintenance (increase likelihood of osteoporosis)
What is endometriosis
Presence of endometrial tissue on other pelvic organs
- endometrium lining moves up into uterine tubes and pours out
- can prevent ovulation or occlude fallopian tubes
- thickens and bleeds with menstruation cycle
- endometriomas can form (associated scarring and adhesion)
- extreme pelvic pain during menstruation and sex
- voiding bladder and bowel (muscle issues)
