Urology: erectile dysfunction

Question 1

Presentation of erectile dysfunction by organic cause (I.e. not psychological) ?

Answer 1

Gradual onset of symptoms
Lack of tumescence - hardening and enlargement of the penis
Normal libido

Question 2

Presentation of erectile dysfunction with a psychogenic cause?

Answer 2

Sudden onset of symptoms
Decrease libido
Good quality spontaneous or self stimulated erections
Major life events
Problem or changes in a relationship
Previous psychological problems
History of premature ejaculation

Question 3

Risk factors for erectile dysfunction?

Answer 3

Increasing age
Cardiovascular disease risk factors: obesity, DM, dyslipidaemia, metabolic syndrome, hypertension, smoking
Alcohol use
Drugs: SSRI, beta blockers

Question 3

Investigations to do for erectile dysfunction?

Answer 3

Q risk – measure lipid and fasting glucose serum levels
Free testosterone (9 to 11 a.m.)
LH, FSH, prolactin levels – to be measured if free testosterone is low


Question 4

How is erectile dysfunction managed?

Answer 4

PDE – 5 inhibitors - sildenafil/Viagra

If cannot take this, can use vacuum direction devices

If young and has always had difficulty achieving an erection, refer to urology

Question 5

What is hypospadias?

Answer 5

Birth defect in boys
Opening of urethra located along shaft of penis and not the tip