Clinical: Male Sexual Dysfunction Flashcards Preview

Block I: Reproduction & Sexuality > Clinical: Male Sexual Dysfunction > Flashcards

Flashcards in Clinical: Male Sexual Dysfunction Deck (47):
1

5 types of male sexual dysfunction

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

2

Define hypogonadism as a male sexual dysfunction

Low libido, decreased energy

3

3 types of ejaculatory disorders 

  • Premature
  • Delayed
  • Painful

4

2 erectogenic centers of the brain

  • Medial preoptic area
  • Hypothalamus paraventricular nucleus

5

Nervous pathway of erection

  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

6

3 molecules involved in erection

  • Nitric oxide
  • cGMP
  • PDE (phosphodiesterase)

7

Role of nitric oxide in erection

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

8

cGMP role in erection

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

9

Role of PDE in erection

Detumescence (cGMP hydrolysis)

10

Concurrent risk associated with ED

Cardiovascular disease

11

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

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

12

Describe how the SHIM score works

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

13

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

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

14

3 lab evaluations specific for ED

Testosterone
FSH
LH

15

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

  • Lipid profile
  • HbA1c
  • Fasting glucose

16

4 roles of testosterone in sexual function

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

17

Why not give men with ED exogenous testosterone

Exogenous T will decrease:

  • Gonadotropins
  • Spermatogenesis

NOTE: Testosterone may be potential male contraceptive

18

6 conditions commonly associated with ED

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

19

METs of sex

3 - 5 (but big inter-individual variation)

20

When is it safe to treat ED?

If patient has no symptoms for activities >5 METs

21

3 PDE5 inhibitors

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

22

Compare the time of peak concentration for the 3 PDE5 inhibitors

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

NOTE: Drug effects may be seen BEFORE peaks

23

compare the half-lives of the 3 PDE5 inhibitors

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

24

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

Viagra and maybe Levitra

25

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

  • Headache
  • Flushing
  • Dyspepsia
  • Nasal congestion

26

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

Altered vision

27

Common side effect of tadalafil only

Myalgia

28

Absolute contraindication of PDE5 inhibitors

Concomitant usage of nitroglycerine in any form

29

Why is nitroglycerine use contraindicated with PDE5 inhibitor use?

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)

30

4 alternatives to PDE5 inhibitors to help rectify ED

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

31

Pros of using vacuum pump

Cost-effective

Mechanical (no chemicals)

>80% effective

32

Cons of vacuum pump

Should not use for >30 min

Complications of bruising and discoloration of glans (>50% dropout rate)

33

Chemical used in MUSE

Prostaglandin E1

34

Pro of MUSE

No need for a needle

35

Con for MUSE

Only >50% effective

36

4 substances involved in intracavernous injection therapy

  • Paperavine
  • Prostaglandin
  • Phentolamine
  • Moxisylyte

37

4 complications of intracavernous injection therapy

  • Pain
  • Bleeding
  • Fibrosis
  • Priapism

38

2 pros of penile prosthesis

~100% effective and able to achieve orgasm

39

2 complications of penile prosthesis

Infection and mechanical failure

40

When is sex therapy effective?

ED is due to psychological issues that are easily accessible

41

When is sex therapy less effective

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

42

Most common sexual complaint

Premature ejaculation

43

2 psychological treatments for premature ejaculation

Stop/start technique

Squeeze technique

44

Medication to treat premature ejaculation

SSRIs

45

Define retarded ejaculation

Delayed ejaculatoin, or no ejaculation

46

Define primary retarded ejaculation

Cause = psychogenic

47

Define secondary retarded ejaculation

Side effect of medication