Psychosexual Dysfunction in Men Flashcards
What is erectile dysfunction?
the inability to attain or retain an erection
Why may a cyclist be at higher risk of erectile dysfunction?
blocking their pudendal nerve so good history is important
What medications have a negative impact on erectile dysfunction?
Antihypertensives
SSRIs
Recreational Substances
Medications acting on testosterone/androgens
Mechanism of Erection
-Erotic stimuli
-neural initiation
-cellular activation
-relaxation of cavernous smooth muscle musculature/ischiocavernosus (cGMP mediated, NO causes dilation of BV)
-stretching of tunica albuginea (reduced venous outflow)
-corpus cavernosum fills with blood
-erection
(PARASYMPATHETIC)
Risk factors for erectile dysfunction
Diabetes hypertension obesity depression low testosterone Dyslipidemia smoking(smooth muscle vasoconstriction)
Factors contributing to ED in Diabetes
apoptosis of penile tissue due to lack of use
polyneuropathy
viagra (amplifies normal response)
impairement of NT synthesis/release
Viagra contraindications
Nitrates
can cause CV collapse
Vaccum devices
Use every day Shave pubic hair at penis root Use lubricant for ring Use smallest ring that you can tolerate Perineal 'milking' if required Remove ring after 30mins Can be used with PDE-5i Contraindicated in anti-coagulated patients and on anti-platelet agents (e.g aspirin)
penis will look purpley as you draw in venous blood
Intracavernous Auto-Injection Therapy
Main side effects:
Priapism
Pain
Fibrosis
What is vaginismus?
Vaginismus is involuntary contraction of muscles around the opening of the vagina in women with no abnormalities in the genital organs. The tight muscle contraction makes sexual intercourse or any sexual activity that involves penetration painful or impossible.
Atrophic Vaginitis
Affects 10 - 40% of post menopausal women
Can lead to :
Avoidance of sexual relationships due to dyspareunia .
Performance anxiety.
Loss of sexual desire
Relationship distress.
Cause of dryness in premenopausal women
folds or rugae
inner lining contains large amount of glycogen
more folds- more lubricant
Causes of dryness in postmenopausal women
loss of folds
loss if inner lining and glandular function
What is the diameter of penile artery in 1 mm?
1mm
What is the drug LEAST likely to reduce sexual desire in women?
Ibuprofen
