Erectile dysfunction Flashcards
(14 cards)
What is erectile dysfunction (ED)?
Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient for satisfactory sexual performance.
Is erectile dysfunction a disease or a symptom?
Erectile dysfunction is a symptom, not a disease, and can have organic or psychogenic causes, with most cases being of mixed aetiology.
What are some common psychogenic causes of erectile dysfunction?
Psychogenic causes include disorders of arousal or sexual intimacy, relationship issues, stress, anxiety, and depression.
What are some organic causes of erectile dysfunction?
Vascular: cardiovascular diseases, hypertension, hyperlipidaemia, peripheral arterial disease, diabetes, smoking, obesity.
Neuronal: multiple sclerosis, Parkinson’s disease, stroke, spinal cord/CNS disease.
Endocrine: diabetes, hypogonadism, hyperprolactinaemia.
Anatomical: Peyronie’s disease, prostate cancer.
Neurogenic: chronic kidney or liver disease, pelvic or urological surgery.
What are some common drugs that can cause erectile dysfunction as a side effect?
Drugs such as antihypertensives, antidepressants, antipsychotics, cytotoxic drugs, and recreational drugs (including alcohol).
What are the risk factors for erectile dysfunction?
Risk factors include a sedentary lifestyle, obesity, smoking, hypercholesterolaemia, and metabolic syndrome.
What should be evaluated in all men with unexplained erectile dysfunction?
Evaluation should include cardiovascular risk factors, and any identified risks should be addressed.
What is involved in the assessment of a man with erectile dysfunction?
Assessment should include asking about sexual relationships, sexual function, mental health, and examining cardiovascular risk factors, signs of testosterone deficiency, external genitalia, and prostate, depending on clinical judgement. Blood tests include HbA1c, lipid profile, and fasting morning total testosterone level.
What is the first-line drug treatment for erectile dysfunction?
An oral phosphodiesterase type-5 inhibitor is the first-line drug treatment, which increases blood flow to the penis but requires sexual stimulation to work.
What are some examples of phosphodiesterase type-5 inhibitors used for erectile dysfunction?
Examples include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra).
How do the phosphodiesterase type-5 inhibitors differ in terms of use?
Sildenafil, vardenafil, and avanafil are short-acting and suitable for occasional use.
Tadalafil is longer-acting and can be used for spontaneous sexual activity or in frequent sexual activity.
What is the NHS prescription criteria for erectile dysfunction drugs?
Some drugs, like sildenafil, can be prescribed without restriction. However, others (like Viagra, tadalafil, vardenafil, and avanafil) may only be prescribed if the patient has certain medical conditions (e.g., diabetes, MS, Parkinson’s, prostate cancer, or has undergone relevant surgeries).
What is the second-line treatment for erectile dysfunction?
Intracavernosal, intraurethral, or topical application of alprostadil (prostaglandin E1) is recommended under medical supervision.
What is priapism, and what should be done if it occurs due to alprostadil?
Priapism is a prolonged erection lasting over 4 hours. If this occurs, the patient should seek medical help. For a prolonged erection lasting more than 6 hours, initial therapy includes penile aspiration and, if unsuccessful, lavage and possibly the use of sympathomimetics (e.g., phenylephrine, adrenaline).
