Clinical: Male Sexual Dysfunction

Question 1

5 types of male sexual dysfunction

Answer 1

• Erectile dysfunction (ED)
• Hypogonadism
• Ejaculatory disorders
• Psychological issues
• Penile deformity

Question 2

Define hypogonadism as a male sexual dysfunction

Answer 2

Low libido, decreased energy

Question 3

3 types of ejaculatory disorders

Answer 3

• Premature
• Delayed
• Painful

Question 4

2 erectogenic centers of the brain

Answer 4

• Medial preoptic area
• Hypothalamus paraventricular nucleus

Question 5

Nervous pathway of erection

Answer 5

1. Erectogenic centers
2. Lumbosacral spinal cord
3. Cavernoud nerves (S2-4)
4. Smooth muscle relaxation in the copora cavernosa
   
   1. Arteries/arterioles
   2. Penile trabeculae

Question 6

3 molecules involved in erection

Answer 6

• Nitric oxide
• cGMP
• PDE (phosphodiesterase)

Question 7

Role of nitric oxide in erection

Answer 7

Release of 2nd messenger in the arteries of the corpus cavernosa

Question 8

cGMP role in erection

Answer 8

2nd messenger to cause a decrease in intracellular Ca2++ –> smooth muscle relaxation –> erection

Question 9

Role of PDE in erection

Answer 9

Detumescence (cGMP hydrolysis)

Question 10

Concurrent risk associated with ED

Answer 10

Cardiovascular disease

Question 11

5 domains examined in the International Inventory of Erectile Function (IIEF)

Answer 11

• Erectile function
• Orgasmic function
• Sexual desire
• Intercourse satisfaction
• Overall satisfaction

Question 12

Describe how the SHIM score works

Answer 12

Score from 0 - 30 where higher = no ED and lower = increasing severity of ED

Question 13

2 importants questions in the Androgen Deficiency in Aging Male (ADAM) questionnaire

Answer 13

• Do you have a decrease in sex drive
• Are your erections less strong

Question 14

3 lab evaluations specific for ED

Answer 14

Testosterone
FSH
LH

Question 15

3 other lab tests that can be used to evaluate male sexual dysfunction

Answer 15

• Lipid profile
• HbA1c
• Fasting glucose

Question 16

4 roles of testosterone in sexual function

Answer 16

• Sexual desire and arousal
• Frequency of sexual activity
• Spontaneous erection
• Ejaculation and orgasm

Question 17

Why not give men with ED exogenous testosterone

Answer 17

Exogenous T will decrease:

• Gonadotropins
• Spermatogenesis

NOTE: Testosterone may be potential male contraceptive

Question 18

6 conditions commonly associated with ED

Answer 18

• Diabetes
• Heart disease
• Hypertension
• Low HDL levels (dyslipidemia)
• Smoking (in men with heart disease or hypertension)
• Depression

Question 19

METs of sex

Answer 19

3 - 5 (but big inter-individual variation)

Question 20

When is it safe to treat ED?

Answer 20

If patient has no symptoms for activities >5 METs

Question 21

3 PDE5 inhibitors

Answer 21

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)

Question 22

Compare the time of peak concentration for the 3 PDE5 inhibitors

Answer 22

• Viagra = 1 hr
• Cialis = 2 hours (slowest)
• Levitra = 0.7 - 0.9 hours (shortest)

NOTE: Drug effects may be seen BEFORE peaks

Question 23

compare the half-lives of the 3 PDE5 inhibitors

Answer 23

• Viagra = 4 hours
• Cialis = 17.5 hours
• Levitra = 4-5 hours

Question 24

Which PDE5 inhibitors can affect food absorption (slow it down)

Answer 24

Viagra and maybe Levitra

Question 25

4 common side effects that one can experience from ALL PDE5 inhibitors

Answer 25

* Headache * Flushing * Dyspepsia * Nasal congestion

Question 26

Common side effect that one can experience with sildenafil and vardenafil only

Answer 26

Altered vision

Question 27

Common side effect of tadalafil only

Answer 27

Myalgia

Question 28

Absolute contraindication of PDE5 inhibitors

Answer 28

Concomitant usage of nitroglycerine in any form

Question 29

Why is nitroglycerine use contraindicated with PDE5 inhibitor use?

Answer 29

Any PDE5 inhibitor can potentiate the hypotensive effect of nitroglycerine and so you must not use them within the same **24 hour period (48 hours for tadalafil)**

Question 30

4 alternatives to PDE5 inhibitors to help rectify ED

Answer 30

* Vacuum pump * MUSE (Medicated Urethral System for Erection) * Intracavernous injection therapy * Penile prosthesis

Question 31

Pros of using vacuum pump

Answer 31

Cost-effective Mechanical (no chemicals) \>80% effective

Question 32

Cons of vacuum pump

Answer 32

Should not use for \>30 min Complications of bruising and discoloration of glans (\>50% dropout rate)

Question 33

Chemical used in MUSE

Answer 33

Prostaglandin E1

Question 34

Pro of MUSE

Answer 34

No need for a needle

Question 35

Con for MUSE

Answer 35

Only \>50% effective

Question 36

4 substances involved in intracavernous injection therapy

Answer 36

* Paperavine * Prostaglandin * Phentolamine * Moxisylyte

Question 37

4 complications of intracavernous injection therapy

Answer 37

* Pain * Bleeding * Fibrosis * Priapism

Question 38

2 pros of penile prosthesis

Answer 38

~100% effective and able to achieve orgasm

Question 39

2 complications of penile prosthesis

Answer 39

Infection and mechanical failure

Question 40

When is sex therapy effective?

Answer 40

ED is due to psychological issues that are easily accessible

Question 41

When is sex therapy less effective

Answer 41

When ED is longstanding and is due to deep.complex psychological processes

Question 42

Most common sexual complaint

Answer 42

Premature ejaculation

Question 43

2 psychological treatments for premature ejaculation

Answer 43

Stop/start technique Squeeze technique

Question 44

Medication to treat premature ejaculation

Answer 44

SSRIs

Question 45

Define retarded ejaculation

Answer 45

Delayed ejaculatoin, or no ejaculation

Question 46

Define primary retarded ejaculation

Answer 46

Cause = psychogenic

Question 47

Define secondary retarded ejaculation

Answer 47

Side effect of medication