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What is a total match and total mismatch score?

match = 000
mismatch = 222


What are the types of match and which is most important?

A, B, DR

A is most important, each one has two subtypes


What is erectile dysfunction/impotence?

the inability to achieve and maintain an erection for sexual performance


In who is erectile dysfunction commonly seen?

in elderly due to erectile capacity decreasing with age


What causes erectile dysfunction?

vascular, neurogenic, iatrogenic, anatomical, hormonal, psychogenic

DM, hypertension, MS, nerve damage, hormonal imblances, atherosceloris, heart disease, unhealthy lifestyle, oebese, alcoholic, smoking, drug abuse, medications, antihypertensive, antipsychotics, antidepressant


What psychological factors can cause erectile dysfunction?

stress, fear, gloom, uncertainty, sadness, relationship problems


Lifestyle choices to help erectile dysfunction?

quit smoking, reduce alcohol, dont abuse drugs, exercise regularly, psychotherpay, talk to partner


What is erectile function?

neurovascular phenomenon under hormonal control causing arterial dilation, smooth muscle relaxation and activation of the corporeal veno occlusive mechanism


Anatomy of the penis?

left and right corpora cavenosa covered by and fused together by tunica albuginea, containing spongy vascular erectile tissue with trabeculated smooth muscle lined by endothelial cells

corpus spongiosum has thinner tunica and contains the urethra, glans penis and bulb of penis


Blood supply of the penis?

internal iliac supplies the internal pudendal which supplied the

dorsal penile - glans penis
cavernosal - spongy tissue of corpora
bulbar - bulb, spngiosum, glans


Venous drainage of the penis?

sinusoids to subtunieal plexus to circumflex veins and deep dorsal veins

corpora cavernosa to cavernous veins to crural veins to internal pudendal veins


Nerve supply of the penis?

erection = s2-s4
relax = t11-l2

cavernous never carries both fibres


Physiology behind an erection?

NO release causes cGMP build up

cGMP dependent pKa activates large conductance, K+ channels open, so hyperpolarising and relaxing vascular and trabecular smooth muscle cells allowing engorment


What is the difference between psychogenic and organic erectile dysfunction?

organic is gradual, no erection in any circumstances and morning erections are effected

psychogenic is sudden, situational and unaffected by morning erections


Causes of hypogonadism?

testicular dysfunction (high LH, low testosterone), hypothalamic dysfunction (low LH as cant produce any), pituritary dysfunction, chronic illness, age


Tests for erectile dysfunction?

nocturnal penile tumescence and rigidity, intracavernosal injection test, duplex USS of penile arteries, arteriography, morning testosterone, fasting glucose, lipid profile


Treatment of erectile dysfunction?

lifestyle, psychosexual counselling, PDE5 inhibitors, ampomorphine SL, intracavernous injections, intraurethral aloprostadil, vacuum device, testosterone replacement, monitor for hepatic and prostatic disease, viagra, change BP meds, start satin, penile prosthesis implantation


How do PDE5 inhibitors treat erectile dysfunction?

increase blood flow, vasodialation and erection via action on NO


What are the 3 types of oral pharmacology for erectile dysfunction?

sildenafil (viagra), tadalafil (Cialis) and vardenafil


How does sildenafil (viagra) work?

60 minute wait after administration, effected by food and alcohol, reduced efficacy after fatty meal, increased erections in diabetics, successful intercourse, cheap and can be prescribed


How does tadalafil work in erectile dysfunction?

30 min wait, maintained for 36 hours, 2 a week, last long time


How does varenafil treat erectile dysfunction?

30 min wait, less effective after fatty meal


When is oral pharacology contraindicated in erectile dysfunction?

concurrent use of nitrates, hypertension, degenerative retinal disorders, unstable angina, stroke, MI, bleeding, peptic ulcer, renal/hepatic impairment


Side effects of oral pharmacology in erectile dysfunction?

headache, flushing, dyspepsia, nasal congestion, dizziness, visual disturbance, back pain, myalgia


Side effect of alpha blockers ?

orthostatic hypotension


How does sublingual apomorphine treat erectile dysfunction?

centrally acting dopamine agonist, sublingual, no CI with nitrates, lower efficacy than PDE5 inhibitors, limited to mild-moderate ED


How does a vacuum constriction device treat erectile dysfunction?

passive engorgment with constricton ring, 90% efficacy and reduced efficacy over time, keeps the blood in the penis due to pressure, causing penis enlargement, use for 30 mins, it is a cold erection


Side effects of a vacuum constriction device for ED?

painful, inability to ejeculate, petechiae, bruises, numbness, expensive


Contraindications of vacuum constriction device for ED?

bleeding disorder or anticoagulants


How do intracavenosal injections treat ED?

inject into copra cavernosa e.g. alprostadil