Erectile Dysfunction

Question 1

Normal male erection is a neurovascular event relying on:
(a) An intact autonomic and somatic nerve supply to the ___,
(b) Arterial blood flow supplied by the paired _____arteries,
(c) Smooth and striated musculature of the corpora cavernosa and pelvic floor

Answer 1

a) penis
b) cavernosal

Question 2

Erection is caused and maintained by:
(a) Increase in_____,
(b) Active relaxation of the smooth muscle within the sinusoids of the corpora cavernosa,
(c) An increase in ______.

Answer 2

a) arterial flow
b) venous resistance

Question 3

What is a key neurotransmitter that initiates and sustains erections?

Answer 3

Nitric oxide

Question 4

What is the consistent inability to attain or maintain a sufficiently
rigid penile erection for sexual performance?

Answer 4

Erectile dysfunction (ED)

Question 5

Organic erectile dysfunction may be an early sign of ______ disease and requires evaluation.

Answer 5

cardiovascular disease

Question 6

Patient history for ED
Loss of libido may indicate a ______ deficiency

Answer 6

androgen

Question 7

True/False
Patient history for ED
Loss of erections may result from arterial, venous, neurogenic, hormonal, or psychogenic causes.

Answer 7

True

Question 8

Patient history for ED
The most common cause of erectile dysfunction is……

Answer 8

a decrease in arterial flow resultant from progressive vascular disease

Question 9

Erectile dysfunction may be an early manifestation of endothelial dysfunction, which precedes more severe _______ disease.

Answer 9

atherosclerotic cardiovascular

Question 10

What medications may be associated with ED?

Answer 10

antihypertensive
antidepressant
opioid agents

Question 11

What is a fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity?

Answer 11

Peyronie disease

Question 12

_______ is the loss of seminal emission

Answer 12

Anejaculation

Question 13

What may result from
1) Androgen deficiency by decreasing prostate and seminal vesicle secretions,
2) Sympathetic denervation as a result of spinal cord injury, diabetes mellitus or
pelvic or retroperitoneal surgery or radiation

Answer 13

Anejaculation

Question 14

Laboratory test to consider for ED:

Answer 14

(1) Lipid profile -Evaluating for dyslipidemia
(2) Glucose- Evaluating for diabetes mellitus
(3) Testosterone - If abnormalities of T are found (hypogonadism)
— Free testosterone (must be drawn between 8-10 AM to be accurate)
—Luteinizing hormone

Question 15

When should Free-T be drawn to be accurate?

Answer 15

8-10 am

Question 16

Treatment for ED

Answer 16

-Lifestyle modifications and reduction of Cardio risk factors
-Men with psychogenic component benefit from sexual health therapy or counseling
-Hormonal replacement offered to men with hypogonadism
—-Managed by UROLOGY
-Oral agents
—Sidenafil (Viagra) 25-100mg PO, 1 hour prior to sexual activity
—Vardenadil (Levitra) 5-20mg PO, 1 hour prior to sexual activity
—Tadalafil (Cialis) 2.5mg PO daily or 10mg PO at least 30 minutes prior to sexual activity
—Avanafil (Stendra) 50-200mg PO, 15 minutes prior to sexual activity
-Other treatments:
(a) Urethral injectable - Prostaglandin E2
(b) Vacuum Erection device
(c) Penile prosthetic surgery
(d) Vascular reconstruction

Question 17

When would you refer to Urology?

Answer 17

(a) Priapism (MEDEVAC)
(b) Initial oral therapy initiation
(c) Inadequate response to oral medications,
(d) Unable to tolerate side effects
(e) Peyronie disease or other penile deformity
(f) History of pelvic or perineal trauma, surgery, or radiation.

Question 18

Complication for ED

Answer 18

Priapism (MEDEVAC)

Question 19

Definition of what?
Occurrence of penile erection lasting longer than 4 hours

Answer 19

Priapism

Question 20

Initial treatment for priapism is what?

Answer 20

-aspiration of blood from the penis
-injection of sympathomimetic drugs (epinephrine or phenylephrine)

Question 21

Lifestyle factors to consider for ED
Note severity, intermittency and timing

Answer 21

1) Sexual orientation
2) Quality of relationship with partner
3) Alcohol
4) Tobacco
5) Marijuana
6) Other recreational drugs
7) Use of pornography to maintain arousal

Question 22

Medical history factors to consider for ED
Note severity, intermittency and timing

Answer 22

1) Medication review
2) Dyslipidemia
3) Hypertension
4) Depression
5) Neurologic disease
6) Pelvic trauma, surgery or irradiation.
7) Prostate cancer
8) Peyronie disease

Question 23

Physical Exam factors to consider for ED
Note severity, intermittency and timing

Answer 23

a) Vital signs (looking for HTN or other signs of cardiovascular disease)
(b) Body habitus (obesity)
(c) Secondary sexual characteristics
(d) Cardiovascular exam
(e) Neurologic exam
(f) Genitalia exam
—Stretched length of penis
— Presence of Peyronie disease
—Abnormalities in size or consistency of testicle

Question 24

When conducting a Genitalia exam for your suspected ED pt what are you going to note?

Answer 24

—Stretched length of penis
— Presence of Peyronie disease
—Abnormalities in size or consistency of testicle

Question 25

ED should be distinguished from problems with….

Answer 25

(a) Deformity
(b) Libido
(c) Orgasm
(d) Ejaculation

Question 26

Refer to urology if……..

Answer 26

(a) Priapism (MEDEVAC)
(b) Initial oral therapy initiation
(c) Inadequate response to oral medications,
(d) Unable to tolerate side effects
(e) Peyronie disease or other penile deformity
(f) History of pelvic or perineal trauma, surgery, or radiation.