Erectile Dysfunction Flashcards
What is an erection?
An erection is a neurovascular, process of contraction and relaxation of penile structures
What systems affect the penis?
Autonomic nervous system and somatic nervous systems
What does the somatic nervous system involve?
The somatic nervous system involves the sensation response of penile tissue when stimulated.
What determines penile relaxation?
Ejaculation
What does the parasympathetic nervous system control?
Initiation of the erection
What is the first part of a male’s sexual stimulation?
Penile erction
What is the definition of erectile dysfunction:
inability to obtain or sustain an erection to completely satisfy sexual intercourse
What processes can be affected during an erection?
Neural, vascular or chemical processes
What are psychogenic causes of erectile dysfunction?
Anxiety Strain in a relationship Depression Psychosis/schizophrenia Treatments for anxiety and depression
Organic causes of ED:
Neurogenic disorders
SCI
Stroke
Parkinson’s
Cerebral trauma
These may reduce sexual drive or the inability to obtain sensory involvement needed to obtain a erection
Organic causes of ED:
Hormonal Causes
Reduction of androgens both primary and secondary
Organic causes of ED:
Surgery
Extensive pelvis surgery or radiation can cause structural damage and nerve dysfunction
Organic causes of ED:
Blood flow
Penile arterial insufficiency
Reduction of blood flow
or conditions which cause vascular compromise over time
First-Line treatments for ED
PDE-5 inhibitors inhibit the breakdown of responses involved in obtaining and sustaining an erection
The presence of penile stimulation in the PDE-5 inhibitors help to reinforce normal cellular activity in smooth muscle of the penis
Facilitates the initiation and maintenance of erection
What are some 1st line medications for ED?
Tadalfil (cialis) 5-20 mg/d
Vardenafil (Levitra) 5-20 mg /d
Sildenafil (Viagra) 25-100 mg/d
What are some Second-Line treatments for ED?
Referral to urology
Intracavernosal injection therapy
Prosthesis
Vacuum erection device
What are the goals of ED therapy?
Maintain an erection
Achieve sexual satisfaction with sustainable erection
Re-evaluate in 6 months
Determine if there are any cardiac risks have changed
What drugs can affect ED?
Alcohol Nicotine Tranquilizers Diuretics Corticosteroids Antihistamines Antiparkinsons Analgesics Antidepressants Antihypertensives Anticonvulsants
What drugs are contraindicated with PDE-5 inhibitors?
Nitrates due to hypotensive effects
What are some side effects of PDE-5 inhibitors?
Priapism is a sustained erection/prolonged erction. If untreated can leave to ischemia and permanent damage to penile tissue.
Priapism is common in sickle cell disease
Headache Flushing nasal congestion Dyspepsia Priapism
What are some risks for ED?
Illicit drug use Prescribed medications Over-the-counter treatments Smoking Comorbid conditions: diabetes, heart disease, hypertension, HLD Age - andropause
What are some patient teaching points and considerations?
Determine the underlying problem, patient, and partner
Discuss the patient and partner’s view of the problem
Discuss pharmacological and nonpharmacological methods of improving ED.
Discuss medical, sexual or psychosocial aspect of ED
