erectile dysfunction

Question 1

name 5 conditions of male sexual dysfunction

Answer 1

• Male Hypogonadism
• Erectile dysfunction > 10-50% of men
• Premature ejaculation > Prevalence rates of 20–30%
• Delayed ejaculation
• Anejaculation and Anorgasmia - the absence of ejaculation and inibility to reach orgasm
• Retrograde ejaculation
• Painful ejaculation
• Haematospermia
• Low sexual desire

Question 2

define Male hypogonadism

Answer 2

• low testosterone on blood tests
  AND
  1 of the following:
  Reduced libido/Erectile dysfunction/Decreased spontaneous/morning erections or fatigue, low mood, decreased motivation

Question 3

primary + secondary hypogonadism

Answer 3

primary - testis not working
- low testosterone
- high LH + FSH

• hereditary causes - Klinefelter syndrome
• acquired - chemo + surgical castration

secondary
testicles are fine - something else is causing low T
- low t
- low LH + FSH

• obesity - T2DM
• copd
  renal disease
  cancer

treatment of both:
- exogenous testosterone

Question 4

autonomic nerves of penis

Answer 4

Parasympathetic S2-4 produce erection
Sympathetic T11-L2 ejaculation & detumescence

point and shoot - mnemonic

Question 5

Erectile dysfunction – risk factors

Answer 5

• Inflammatory: Prostatitis
• Mechanical: Peyronie’s disease
• Psychological: Depression, anxiety, stress, relationship difficulties
• Occlusive (vascular): smoking, PVD, HTN, hyperlipidaemia, DM
• Trauma: pelvic fracture, SCI, penile fracture or trauma
• Extra: pelvic surgery, prostatectomy, priapism, penile cancer
• Neurogenic: MS, stroke, spina bifida, peripheral neuropathy
• Chemical: antihypertensives, antidepressants, antipsychotics, anticonvulsants, statins, GNRH analogues, alcohol, cannabis, cocaine, heroin, diuretics
• Endocrine: DM, hypogonadism, hyperprolactinaemia, hypo/hyperthyroidism, hypo/hypercortisolism

Question 6

Erectile dysfunction – History

Answer 6

• onset
• duration
• labido
  useful in funding out if organic or psychological
• drugs
• smoking
• alcohol

erectile dysfunction questionnaire - IIEF

Question 7

Erectile dysfunction – Examination

Answer 7

• Cardiovascular
• Abdomen
• Neurological
• Penis: Peyronie’s plaques, phimosis, deformities / lesions
• Testes: presence, size & location
• DRE: assess prostate, also part of near exam

Question 8

testing

Answer 8

• BP
  bloods:
• fasting glucose
• lipid
• early mornring testosterone

other:
- LH/FSH
- penile doppler USS

Question 9

Treatment

Answer 9

• Counselling (relaxation therapy)
• Lifestyle advice (alcohol & drug use)
• Topical agents – Alprostadil creams
• Vacuum device
• Oral – phosphodiesterase inhibitors
• Injectables – Alprostadil
• Penile Implants:
  Soft
  Malleable
  Inflatable

Question 10

outline the mainanatomical parts of the male genitalia and its function

Answer 10

shaft - the penile body consisting of:
- corpus cavernosa - erectile tissues that fill w blood - dorsal side
- corpus spongiosum - surrounds urethra, ensuring it remains open during erection - head forms glans

• glans - head of penis
• urethra - carries urine and semen to outside
• foreskin
• scrotum - sac which holds testes - contains dartos and cremaster muscle
• testes - produce sperm and testosterone
• seminal vesicles - secrete seminal fluid
• prostate gland - produces fluid for ejaculation
• bulbourethral glands - produces pre-ejaculant fluid