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Repro / GU > SM_232b: Male Sexual Dysfunction > Flashcards

SM_232b: Male Sexual Dysfunction Flashcards

1
Q

Erectile dysfunction is ____

A

Erectile dysfunction is inability to achieve or maintain an erection firm enough to have sexual intercourse

  • Accompanied by performance anxiety
  • Peaks at 70-79
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2
Q

Tunica albuginea is a ____

A

Tunica albuginea is a bilayered structure with outer longitudinal layer and inner circular fibers

  • High tensile strength
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3
Q

Arterial inflow to penis is ____

A

Arterial inflow to penis is pudendal artery

  • Common penile artery branches into superficial dorsal artery and deep cavernosal artery
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4
Q

Venous outflow to penis has 4 sources of drainage: ____, ____, ____, and ____

A

Venous outflow to penis has 4 sources of drainage: dorsal vein, spongiosal veins, crural veins, and cavernosal veins

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5
Q

Neural innervation of penis is ____ from ____

A

Neural innervation of penis is parasympathetic (NANC) from S2-4

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6
Q

Erection involves ____ and ____

A

Erection involves expansion of the corpora cavernosa and corpus spongiosum and thinning of the tunica albuginea

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7
Q

Describe the normal pathway to erection

A

Normal pathway to erection

  1. Sexual impulse (nerve signal)
  2. Neurotransmitter (nitric oxide release)
  3. Penile smooth muscle relaxation / arteries
  4. Start of rigidity (increase in sinusoidal blood flow)
  5. Compression of helical veins
  6. Erection
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8
Q

Describe male sexual response cycle

A

Male sexual response cycle

  1. Appetitive phase
  2. Excitement
  3. Plateau
  4. Orgasm
  5. Resolution
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9
Q

____ is main CNS center for erection

A

Hypothalamus is main CNS center for erection

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10
Q

Spinal cord erection generating center is ____

A

Spinal cord erection generating center is T10-L3

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11
Q

Describe cellular mechanisms of erection

A

Cellular mechanisms of erection

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12
Q

Describe erectogenic neurotransmitters

A

Erectogenic neurotransmitters

  • PGE1
  • cAMP
  • cGMP
  • ACh
  • VIP
  • Dopamine
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13
Q

____ and ____ are erectolytic neurotransmitters

A

Epinephrine and GABA are erectolytic neurotransmitters

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14
Q

Describe vascular risk factors for erectile dysfunction

A

Vascular risk factors for erectile dysfunction

  • Diabetes
  • HTN
  • HLD
  • Cigarette smoking
  • CAD (MI, CABG, PTCA)
  • PVD
  • Cerebrovascular disease
  • Pelvic / perineal disease
  • Pelvic surgery
  • Pelvic radiation therapy
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15
Q

Erectile dysfunction and vascular diseases are states of ___

A

Erectile dysfunction and vascular diseases are states of endothelial dysfunction

  • Pelvic vascular surgery and angioplasty improve erectile dysfunction
  • CVD is a predictor of erectile dysfunction
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16
Q

Erectile dysfunction is categorized as ___, ___, or ___

A

Erectile dysfunction is categorized as psychogenic / loss of confidence, organic, or mixed

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17
Q

Describe physical exam for erectile dysfunction

A

Physical exam for erectile dysfunction

  • BMI and waist circumference are independent predictors of ED
  • Examine chest for gynecomastia
  • Assess secondary sex characteristics for hypogonadism: beard, pubic heart
  • Penis: flaccid stretch, skin lesions, hypospadias - evaluate for Peyronie’s
  • Scrotum: testis location, testis size, consistency
  • Digital rectal exam: prostate pathology, bulbocavernous reflex (Osinski’s reflex)
18
Q

Describe sexual health inventory for men (SHIM)

A

Sexual health inventory for men (SHIM)

  • 1-7: severe ED
  • 8-11: moderate ED
  • 12-16: mild / moderate ED
  • 17-21: mild ED
  • 22-25: no ED
19
Q

Laboratory study for erectile dysfunction includes ____

A

Laboratory study for erectile dysfunction includes early morning total testosterone level

20
Q

Describe role of penile duplex doppler ultrasound

A

Penile duplex doppler ultrasound

  • Define erectile hemodynamics
  • Assess arterial inflow: occult / future CAD
  • Assess venocclusive function: venous leak as a prognostic factor
21
Q

Describe diagnosis of erectile dysfunction

A

Diagnosis of erectile dysfunction

  • Penile duplex doppler ultrasound
  • Nocturnal penile tumescence and rigidity
  • Biothesiometry
22
Q

Describe treatment of erectile dysfunction

A

Erectile dysfunction treatment

  • Phase I: oral medication (PDE-5 inhibitors)
  • Phase II: intraurethral suppository, intracavernosal injection, vacuum erection device
  • Phase III: penile prosthesis, penile revascularization
  • Optimize / current comorbidities: control DM / HTN / HLD, treat thyroid deficiency, lifestyle modification, consider psychosexual therapy
23
Q

____ used to treat chronic conditions are associated with erectile dysfunction

A

Medications used to treat chronic conditions are associated with erectile dysfunction

24
Q

Sildenafil, Tadalafil, Vardenafil, and Avanafil are ___

A

Sildenafil, Tadalafil, Vardenafil, and Avanafil are PDE-5 inhibitor

  • Switch to another PDE-5 inhibitor to avoid bothersome side effects
  • Generally well-tolerated and effective
  • Contraindications: nitrates, amyl nitrate, people for whom intercourse is not advisable, and caution with alpha-blockers or HIV meds
25
Q

Side effects of PDE-5 inhibitors are ____, ____, ____, ____, and ____

A

Side effects of PDE-5 inhibitors are flushed face, headache, nasal congestion, gastric reflux, and muscle / back pain

26
Q

If PDE-5 inhibitors fail for erectile dysfunction, switch to more ___ treatment

A

If PDE-5 inhibitors fail for erectile dysfunction, switch to more invasive treatment

  • VED
  • Intraurethral agents
  • Intracavernosal agents
  • Penile prosthesis
27
Q

Intraurethral alprostadil (PGE1) ____

A

Intraurethral alprostadil (PGE1) promotes NO synthesis, leading to smooth muscle relaxation and penile vasodilation

28
Q

____ uniformly produces erection

A

Vacuum erection device uniformly produces erection

29
Q

Intracavernosal injection for erectile dysfunction can be with ____ or ____

A

Intracavernosal injection for erectile dysfunction can be with alprostadil (PGE1) or some mix of phentolamine / papverine / PGE1 / atropine

30
Q

Penile prosthesis is ___ or ___

A

Penile prosthesis is malleable (semirigid) or inflatable

  • High satisfaction rate
31
Q

Ejaculation is a ___

A

Ejaculation is a reflex involving interplay between somatic, sympathetic, and parasympathetic pathways modulated by dopamine and serotonin

32
Q

Antegrade ejaculation consists of ____ and ____

A

Antegrade ejaculation consists of emission and expulsion

  • Emission: sympathetic spinal cord reflex, semen introduced into posterior urethra
  • Expulsion: combined action of sympathetic and somatic pathways
  • Interplay between peri-urethral muscle contractions, bladder neck closer, and relaxation of external sphincter
  • Orgasm is a pleasurable sensation resulting from cerebral processing of the increased pressure in the posterior urethra and contraction of the bulbar urethra bulb and accessory sexual organs
33
Q

Describe parts of CNS involved in ejaculation

A

Parts of CNS involved in ejaculation

  • Medial preoptic area, paraventricular nucleus, nucleius paragigantocellularis
  • L3-L4: spinal ejaculatory generator
  • T10-L2: secretory center (sequential contractions of epididymis, vas deferens, seminal vesicles, and prostate and closure of bladder neck)
  • S2-4: mechanical center (contractions of bulbospongiosus, bulbocavernosus, and perineal muscles)
34
Q

Describe neurotransmitters involved in ejaculation

A

Neurotransmitters involved in ejaculation

35
Q

Describe role of hormones in erectile dysfunction

A

Hormones in erectile dysfunction

  • Testosterone: high -> premature ejaculation, low -> delayed ejaculation
  • Thyroid: high -> premature ejaculation, low -> delayed ejaculation
  • Prolactin: high levels suppress testosterone and ejaculatory function
  • Oxytocin: increases ejaculation, paternal nurturing, sexual desire and long-term bonds and attachments
36
Q

Lifelong premature ejaculation is ____

A

Lifelong premature ejaculation is poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut

37
Q

Premature ejaculation can be ____, ____, ____, or ____

A

Premature ejaculation can be lifelong, acquired, natural variable, and subjective

38
Q

Premature ejaculation is treated with ____, ____, and ____

A

Premature ejaculation is treated with behavioral therapy, transdermal therapy, and SSRIs

  • Behavioral therapy: stop / start technique, squeeze technique, partner required, poor compliance, and poor sustainability
  • Transdermal therapy: lidocaine and prilocaine, needs transdermal permeator
39
Q

Delayed orgasm is ___

A

Delayed orgasm is persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation which causes personal distress

  • Hormonal imbalances, medication, penile sensation loss, hyperstimulation, or psychiatric
40
Q

____, ____, ____, and ____ may be used to treat delayed orgasm

A

Buproprion, cyproheptadine, amantadine, and yohimbine may be used to treat delayed orgasm

Repro / GU (46 decks)

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