21. Psychosexual dysfunction in men and women

Question 1

Why do we need to highlight the importance of better sex?

Answer 1

sexual problems have adverse effects on interpersonal relationship and quality of life.

Question 2

Most common sexual problems

Answer 2

Most common in women: 43% of women affected, 31% of men

Low desire, arousal problem, lack of orgasm and pain during sex more common in women

Rapid orgasm more common in men

Question 3

Erectile dysfunction and male sexual dysfunctions

Answer 3

The persistent inability to attain and /or maintain an erection sufficient for sexual performance >3-6 months
Initially intermittent hence men present later
Ejaculation disorders- Premature/ Retarded (delayed)/Retrograde
Loss of sexual desire - psychological, hormonal - ?low Testosterone
Primary / Secondary/ Situational (includes Porn induced erectile dysfunction)

Bold issues more likely to be present in diabetics

Question 4

How do you assess an erection?

Answer 4

Erection hardness scoring tool
Grades 1-4
Grade 1: penis is larger but not hard. Texture of bottom lip
Grade 2: penis is hard but not hard enough for penetration. Tongue pressing into cheek.
Grade 3: penis is hard enough for penetration but not completely hard. Tip of nose.
Grade 4: penis is completely hard and fully rigid. Top of scalp

Corpus cavernosa fills with blood, this is what you’re feeling for so need to press in a bit.

Question 5

Organic causes of erectile dysfunction

Answer 5

> 40% cardiovascular
30% diabetes
15% medicinal

Question 6

Some drugs with negative impact on erectile dysfunction

Answer 6

Antihypertensives
SSRI
Marijuana
Opiates
Cocaine
Nicotine
Alcohol

Question 7

Mechanism/physiology of erections

Answer 7

1. Erotic stimuli
2. Neural initiation
3. Cellular activation
4. Relaxation of cavernous smooth muscle
5. Erection

Pathway:
L-Arginine - NO - Guanylate cyclase - cGMP – Phosphodiesterase5 – Pathway

Question 8

Layers of penis

Answer 8

Skin
Tunica dartos - most superficial layer, around superficial veins
Buck’s fascia - around corp. cavernosum & corp spongiosum
Tunica Albuginea - Very firm (1,7-3,3 mm)Few elastic fibres.
Excludes corp. spongiosum

Question 9

Erectile dysfunction is an early marker of what?

Answer 9

Coronary artery disease

Question 10

Smoking and erectile dysfunction

Answer 10

Nicotine causes smooth muscle vasoconstriction
Tobacco use is an independent risk factor for ED.
Significantly interferes with the cavernous veno-occlusive mechanism.
Smoking cigarettes before an intracavernous injection of Papaverine reduced the erectile response.

Question 11

Diabetes and erectile dysfunction

Answer 11

Men with diabetes develop erectile dysfunction 10 -15 years earlier than men without diabetes.
50 -60% of all diabetic men over the age of 50 years will experience erectile dysfunction

Question 12

Factors contributing to ED in diabetes

Answer 12

Angiopathy
-reduced blood flow

Polyneuropathy
-reduced sensation, motor drive or pain

Impairment of neurotransmitter synthesis/release
-reduced erectile function

Endothelial and smooth muscle cell dysfunction
-limited muscle relaxation and poor blood flow

Impairment of cavernous tissue architecture
- limited inflow of blood and poor swelling

Lack of use causes smooth muscle apoptosis
- Reduction in length and fibrosis -> poor function
Will need to take viagra and try to masturbate or get aroused to fill it with oxygenated blood to keep it alive

Question 13

Cardiorespiratory fitness

Answer 13

Meta-analysis of cardio‐respiratory fitness studies:
1 MET higher level of maximal aerobic capacity associated with 13% reduction in all cause mortality and a 15% reduction in CVD/CHD mortality
This level of improvement in aerobic capacity is comparable to:
7cm reduction in waist circumference,
5mmHg reduction in systolic BP,
1 mmol/L reduction in triglycerides in males
1mmol/L reduction in fasting plasma glucose
0.2mmol/L increase in HDL1