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Erectile Dysfunction Flashcards

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1
Q

What type of physiological process is penile erection?

A

Penile erection is a neurovascular phenomenon under hormonal control in a physiologic environment.

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2
Q

Which nervous system controls erection and which controls detumescence?

A

Erection is controlled by the parasympathetic nervous system (S2-S4).

Detumescence (loss of erection) is controlled by the sympathetic nervous system (T11-L2).

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3
Q

What are the two main mechanisms that contribute to penile erection?

A

Central Mechanism – Stimuli such as visual, auditory, olfactory, or imagined inputs.

Somatic Mechanism – Mechanical stimulation of the penis.

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4
Q

What is the main biochemical pathway involved in penile erection?

A

The Nitric Oxide (NO) / cGMP pathway, which mediates smooth muscle relaxation in the corpus cavernosum, leading to increased blood flow and erection.

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5
Q

What is the role of nitric oxide (NO) in the NO/cGMP pathway?

A

NO is released by endothelial cells and parasympathetic nerves, stimulating guanylate cyclase, which increases cyclic GMP (cGMP) levels, leading to smooth muscle relaxation and vasodilation.

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6
Q

How does cGMP contribute to penile erection?

A

cGMP relaxes smooth muscle in the corpus cavernosum, allowing blood to fill the penile sinusoids, leading to erection.

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7
Q

What enzyme degrades cGMP, leading to detumescence?

A

Phosphodiesterase type 5 (PDE5) breaks down cGMP into GMP, leading to smooth muscle contraction and detumescence.

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8
Q

How do PDE5 inhibitors like sildenafil (Viagra) enhance erection?

A

PDE5 inhibitors prevent the breakdown of cGMP, prolonging smooth muscle relaxation and increasing blood flow to the penis, maintaining erection.

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9
Q

What enzyme does nitric oxide (NO) activate in the NO/cGMP pathway?

A

Guanylate cyclase, which catalyzes the conversion of GTP to cyclic GMP (cGMP).

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10
Q

What is the precursor molecule for cGMP production?

A

Guanosine triphosphate (GTP) is the precursor for cGMP production.

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11
Q

What is the main product of guanylate cyclase activation?

A

Cyclic guanosine monophosphate (cGMP), which mediates smooth muscle relaxation and vasodilation.

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12
Q

What stimulates the conversion of GTP to cGMP?

A

Nitric oxide (NO) binds to and activates soluble guanylate cyclase, leading to cGMP production.

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13
Q

What happens when cGMP levels increase in the corpus cavernosum?

A

Increased cGMP reduces intracellular calcium, leading to smooth muscle relaxation, vasodilation, and penile erection.

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14
Q

How does phosphodiesterase type 5 (PDE5) regulate cGMP levels?

A

PDE5 breaks down cGMP into GMP, decreasing smooth muscle relaxation and leading to detumescence.

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15
Q

What is the role of calcium in the NO/cGMP pathway?

A

High intracellular calcium causes smooth muscle contraction, while cGMP lowers calcium levels, promoting smooth muscle relaxation and erection.

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16
Q

Define ED

A

ED is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

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17
Q

Risk factors of ED

A

Cardiovascular
- Metabolic Syndrome
- Obesity
- Smoking
-Hypercholesterolemia
- Sedentary lifestyle
Diabetes Mellitus
Radical prostatectomy (25-75%)

Poor general health
Other genitourinary disease
Psychological/Psychiatric
HIV
Alcohol
Chronic renal Failure

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18
Q

Classification of ED

A

Cause
Mechanism

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19
Q

Mechanism in which ED can happen

A
  1. Failure to initiate (neurogenic)
  2. Failure to fill (Arterial)
  3. Failure to store (venous)
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20
Q

Causes classification of EDv

A

Organic
Psychogenic

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21
Q

Psychogenic causes of ED

A

Generalised
Situational

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22
Q

Organic causes of ED

A

Vasogenic
Neurogenic
Anatomical
Endocrinology

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23
Q

What are the main neurogenic causes of erectile dysfunction (ED)?

A

Neurogenic causes can be categorized into brain, spinal cord, cavernous nerves, and pudendal nerves disorders.

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24
Q

What brain-related conditions can cause neurogenic erectile dysfunction (ED)?

A

Parkinson’s disease
Stroke
Temporal lobe epilepsy (TLE)
Encephalitis
Brain tumors
Dementia
Traumatic brain injury (TBI)

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25
How can spinal cord disorders lead to erectile dysfunction (ED)?
Tumors and myelitis affecting the spinal cord can disrupt nerve pathways responsible for erection.
26
How do cavernous nerve injuries contribute to erectile dysfunction (ED)?
Damage to cavernous nerves can impair the neurovascular control of erection. Causes include: - Radical prostatectomy (nerve damage during prostate surgery) - Abdominoperineal (AP) resection - Pelvic fractures - Diabetes mellitus (DM) (leading to autonomic neuropathy)
27
How does pudendal nerve damage cause erectile dysfunction (ED)?
Sensory neuropathy of the pudendal nerve impairs sensory feedback and reflexive erection.
28
What are the main endocrinological causes of erectile dysfunction (ED)?
1. Hypogonadism (low testosterone) - Hypogonadotropic hypogonadism - Hypergonadotropic hypogonadism 2. Hyperprolactinaemia 3. Hyperthyroidism 4. Hypothyroidism
29
What is hypogonadism, and how does it cause erectile dysfunction (ED)?
Hypogonadism is a testosterone deficiency that leads to decreased libido, poor erectile function, and reduced energy levels.
30
What is the difference between hypogonadotropic and hypergonadotropic hypogonadism?
Hypogonadotropic hypogonadism: Low testosterone due to low gonadotropins (LH/FSH) from the pituitary/hypothalamus. Hypergonadotropic hypogonadism: Low testosterone due to primary testicular failure, leading to high LH/FSH levels.
31
How does hyperprolactinaemia contribute to erectile dysfunction (ED)?
High prolactin suppresses gonadotropin-releasing hormone (GnRH), leading to low testosterone levels and reduced libido.
32
How does hyperthyroidism cause erectile dysfunction (ED)?
Excess thyroid hormones can cause increased sex hormone-binding globulin (SHBG), reducing free testosterone levels and affecting erectile function.
33
How does hypothyroidism contribute to erectile dysfunction (ED)?
Low thyroid hormones reduce testosterone metabolism, leading to low libido, fatigue, and vascular dysfunction, which impair erections.
34
What are the two main arteriogenic causes of erectile dysfunction (ED)?
Atherosclerotic and traumatic vascular diseases.
35
How does atherosclerosis contribute to erectile dysfunction (ED)?
Atherosclerosis reduces blood flow to the corpus cavernosum by narrowing arteries, impairing the ability to achieve or maintain an erection.
36
What systemic vascular diseases are associated with arteriogenic erectile dysfunction (ED)?
Ischemic heart disease (IHD) Cerebrovascular accident (CVA/stroke) Peripheral vascular disease (PVD)
37
How does hypertension (HPT) lead to erectile dysfunction (ED)?
Hypertension: Reduces nitric oxide (NO) release, impairing smooth muscle relaxation. Increases smooth muscle (SM) tone, leading to arterial stiffness and reduced penile blood flow.
38
What are the traumatic causes of arteriogenic erectile dysfunction (ED)?
Blunt trauma (e.g., pelvic fractures) Penetrating trauma (e.g., gunshot or stab wounds) Long-distance cycling (due to compression of perineal arteries and nerves)
39
What are the main vasogenic (cavernous) causes of erectile dysfunction (ED)?
1. Degenerative changes (e.g., Peyronie’s disease, aging, diabetes mellitus) 2. Trauma (e.g., penile fracture, deep dorsal vein ligation) 3. Acquired venous shunts (e.g., priapism) 4. Insufficient smooth muscle relaxation 5. Irradiation
40
How does Peyronie’s disease cause erectile dysfunction (ED)?
Peyronie’s disease leads to fibrotic plaque formation in the tunica albuginea, causing penile curvature, pain, and difficulty achieving a functional erection.
41
Why does aging contribute to erectile dysfunction (ED)?
Aging leads to degenerative vascular changes, reduced endothelial nitric oxide (NO) production, and decreased smooth muscle compliance, impairing erection.
42
How does diabetes mellitus (DM) contribute to vasogenic erectile dysfunction (ED)?
Diabetes causes endothelial dysfunction, autonomic neuropathy, and smooth muscle fibrosis, leading to impaired arterial inflow and venous trapping.
43
What traumatic injuries can lead to vasogenic erectile dysfunction (ED)?
Penile fracture (rupture of the tunica albuginea) Deep dorsal vein ligation (vascular damage affecting venous outflow)
44
How do acquired venous shunts (e.g., priapism) cause erectile dysfunction (ED)?
Priapism can lead to venous leakage, preventing adequate venous occlusion, which is necessary for maintaining an erection.
45
Why does insufficient smooth muscle (SM) relaxation cause erectile dysfunction (ED)?
Without proper SM relaxation, the cavernosal sinusoids cannot fully expand, leading to inadequate arterial filling and venous trapping failure.
46
How does irradiation contribute to erectile dysfunction (ED)?
Radiation therapy can cause vascular damage, fibrosis, and nerve injury, leading to reduced penile blood flow and impaired erectile function.
47
How does irradiation contribute to erectile dysfunction (ED)?
Radiation therapy can cause vascular damage, fibrosis, and nerve injury, leading to reduced penile blood flow and impaired erectile function.
48
Which class of antihypertensive drugs is associated with an increased risk of erectile dysfunction (ED), at twice the rate of placebo?
Diuretics
49
Which type of beta-blocker is associated with erectile dysfunction (ED)?
Non- selective beta blockers
50
Do selective β1 blockers cause erectile dysfunction (ED)?
No
51
How do α1 blockers affect erectile dysfunction (ED)?
They decrease ED rate but may cause retrograde ejaculation
52
Which adrenergic receptor blocker is known to cause erectile dysfunction (ED)?
a2 blockers
53
Do angiotensin-converting enzyme (ACE) inhibitors cause erectile dysfunction (ED)?
No
54
What effect do angiotensin II receptor blockers (ARBs) have on erectile dysfunction (ED)?
They decrease the ED rate
55
Do calcium channel blockers have any effect on erectile dysfunction (ED)?
Nov
56
What are the main drug classes that can cause erectile dysfunction (ED)?
Psychotropic medications (Antipsychotics, Antidepressants, Anticonvulsants) Hormonal drugs (Antiandrogens, 5-alpha reductase inhibitors, Androgen receptor blockers) Miscellaneous drugs (Digoxin, Cimetidine, Opioids)
57
How do antipsychotics contribute to erectile dysfunction (ED)?
Antipsychotics block dopamine receptors, reducing libido and interfering with prolactin regulation, which can suppress testosterone and impair erections.
58
How do antidepressants cause erectile dysfunction (ED)?
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants can inhibit nitric oxide (NO) release, impairing smooth muscle relaxation and reducing penile blood flow.
59
Why do anticonvulsants contribute to erectile dysfunction (ED)?
Some anticonvulsants depress central nervous system activity, reducing libido and interfering with neural control of erection.
60
How do antiandrogens and androgen receptor blockers cause erectile dysfunction (ED)?
These drugs block testosterone action, leading to decreased libido and impaired erectile function.
61
What is the mechanism by which 5-alpha reductase inhibitors (e.g., finasteride, dutasteride) cause erectile dysfunction (ED)?
These drugs inhibit the conversion of testosterone to dihydrotestosterone (DHT), reducing libido and affecting erectile function.
62
How does digoxin contribute to erectile dysfunction (ED)?
Digoxin has direct negative effects on testosterone production, leading to reduced libido and erectile dysfunction.
63
How does cimetidine cause erectile dysfunction (ED)?
Cimetidine is an H2-receptor antagonist that has antiandrogenic effects, leading to reduced testosterone levels and erectile dysfunction.
64
Why do opioids cause erectile dysfunction (ED)?
Opioids suppress gonadotropin-releasing hormone (GnRH), leading to decreased testosterone levels and reduced sexual function.
65
What is the definition of primary erectile dysfunction (ED)?
Primary ED is a lifelong inability to initiate or maintain an erection sufficient for sexual activity.
66
What percentage of primary erectile dysfunction (ED) cases are psychological?
About 15% of primary ED cases have a psychological cause.
67
What congenital penile abnormality can be associated with primary erectile dysfunction (ED)?
Micropenis, sometimes with chordee (ventral penile curvature), can be a cause.
68
What vascular abnormalities can contribute to primary erectile dysfunction (ED)?
Hypoplasia of penile arteries (underdeveloped arterial supply) Aberrant venous drainage (excessive venous outflow, preventing adequate erection)
69
What are some neurological causes of primary erectile dysfunction (ED)?
Congenital neurological defects affecting penile innervation can lead to primary ED.
70
What are some neurological causes of primary erectile dysfunction (ED)?
Congenital neurological defects affecting penile innervation can lead to primary ED.
71
Generalised causes of ED
Generalised unresponsivemens Generalised inhibition
72
Situational causes off ED
Partner related Performance related Psychological distress
73
What is the primary mechanism behind psychogenic erectile dysfunction (ED)?
Direct central inhibition of sexual arousal and erectile function, often due to psychological factors like stress, anxiety, or depression.
74
How does excessive sympathetic outflow contribute to psychogenic erectile dysfunction (ED)?
Excessive sympathetic activity increases norepinephrine release, causing smooth muscle contraction in the penile vasculature, inhibiting blood flow and preventing erection.

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