3.7 Male Sexual Function and Ageing

Question 1

What are the functions of the testes?

Answer 1

Hormonal - secretion of testosterone - Leydig cells
Fertility - maturation and release of spermatozoa
(look at images)

Question 2

Why does andropause happen?

Answer 2

Decreased production of testosterone
Increased loss of Leydig cells - apoptosis
Lack leutanising hormone response (LH)
Chronic health problems
Obesity
Decreased tissue responsiveness to testosterone - chronic diseases

Question 3

What are the effects of andropause?

Answer 3

Decreased sexual function
Mood changes 
Fatigue/sleep disturbances 
Decreased muscle/Increased fat
Decreased bone material - osteoporosis 
Decreased Hb

Question 4

What are the pros and cons of HRT for men?

Answer 4

Pros

• Increase muscle mass
• decreased fat
• increased well being

Cons
- gentle exercise programme has the same effect
- risk of prostate cancer
- impact on CVS controversial
(revise spermatogenesis)

Question 5

How is fertility affected by old age?

Answer 5

Continued division of germ cells
Variable effects of ageing
Reduced Sertoli cell functional
Male Fertility is affected, but not consistently so
Impact of male aging on developmental problems

Question 6

How is the secretory function of the prostate affected?

Answer 6

Reduced secretion of seminal plasma
• Reduced ejaculate volume
• Thicker/thinner semen
Reduced force of ejaculation

Question 7

What are the types of prostatic neoplasia?

Answer 7

Benign - 70% of 70 year olds

Malignant - 3% of 70 year olds

Question 8

How is the sexual function affected?

Answer 8

Decreased desire 
Prolonged arousal 
Decreased penile sensitivity 
Reduced erectile rigidity
Decreased intensity of orgasm 
Increased refractory period

Question 9

What are the causes of erectile dysfunction?

Answer 9

Persistent inability to initiate or sustain penile erection sufficient for satisfactory sexual activity
	• Ageing
	• Psychological
	• Vascular (­ with age)
          Diabetes (­ with age)

Question 10

What is the pathophysiology of an erection and what could go wrong?

Answer 10

Stimulus - decreased desire 
Release of NO - nerve damage
cGMP formation - cell toxins
Smooth muscle relaxation - failure 
Influx of blood into the sinusoids - blocked or narrow arteries

Question 11

What are the major risk factors of ED?

Answer 11

Depression (in order)
Diabetes 
Peripheral vascular disease
IHD 
Hyperlipideamia 
Hypertension

Question 12

What could cause failure of the cavernosal smooth muscle to relax?

Answer 12

Loss of input 
	• Central mechanisms (psychogenic)
           Peripheral nerves (neurogenic)
• Smooth muscle dysfunction
	• Toxins
           Diabetes
• Vascular disease
	• Large vessel – PVD
	• Medium vessel – IHD
          Microvasculature - Diabetes

Question 13

What tests would you do for the diagnosis of ED?

Answer 13

Screen for physical risk factors
○ Diabetes – blood sugar
○ Heart disease – Lipid profile
○ Androgen deficiency – Testosterone level

Question 14

What are the risk factors of ED?

Answer 14

○ Advanced age
		○ Diabetes
		○ Cardiovascular disease
		○ Hypertension & also usage of certain BP drugs
		○ Certain neurological problems including trauma
		○ Obesity
		○ Smoking
		○ Heavy alcohol consumption
Lack of exercise…too much cycling!!

Question 15

What are the treatment of ED?

Answer 15

• Direct therapies
• Psychological (psychosexual)
• Behavioral (Sex therapy: Masters and Johnson)
• Pharmacological
Physical
• Drugs
Thiazide diuretics, ACE inhibitors, anti-depressants

Question 16

What are the centrally acting drug therapies used for ED?

Answer 16

Centrally acting (not widely used)
• Apomorphine (dopamine agonist) – discontinued - vomiting
Melanocortin agonists

Question 17

What are the smooth muscle relaxants used for ED?

Answer 17

• Oral: Phosphodiesterase 5 inhibitors (PDE5Is)
	• Sildenafil (Viagra)
	• Tadalafil (Cialis)
	• Vardenafil (Levitra)
• Intra cavernosal injections
Prostaglandin E1

Question 18

What does PDE5 do?

Answer 18

converts cGMP into G’GMP