Lecture 12: Male Sexual Dysfunction Flashcards
(34 cards)
What components are required for NORMAL male sexual function?
- Libido
- Penile erection
- Ejaculation
- Detumescence
What are the two neuro pathways that control erection?
- Early males: Peripheral (reflexogenic) S2-S4
- Mature males: Central (Psychogenic) T11-L2
AKA when you’re young, touching it makes it erect.
What is the primary neurotransmitter in erection?
Nitric Oxide, which promotes vascular relaxation to start and maintain an erection.
What part of the penis becomes engorged with blood and what keeps it engorged?
- Corpus cavernosa gets engorged
- Trabecular smooth muscle compresses to keep the blood in.
What part of the nervous system controls ejaculation?
Sympathetic NS
What 3 things mediate detumescence?
- NE
- Endothelin
- Smooth muscle contraction
Is ED part of the aging process?
No!
However, does occur in older men generally.
What organ disease can affect ED?
CV disease
Vascular disorders in general.
What are the 3 primary mechanisms that result in ED?
- Can’t initiate erection (psycho, endo, neuro)
- Can’t fill penile tissue (arteriogenic)
- Can’t store blood properly (venoocclusive)
In a majority of ED cases, what are the common risk factors?
- DM
- Atherosclerosis
- Medication
What is the MC organic cause of ED?
Vasculogenic
What two endocrine abnormalities can cause ED?
- Low testosterone
- Increased prolactin
What medications are known to cause ED?
- Thiazides
- BBs
- Hormones (estrogen, GnRH)
- Antidepressants (SSRIs & TCAs)
- H2 antagonists
What managment option should we do if there is no response to oral meds for ED?
Direct injection of meds
If there is no response to injections for ED, what diagnostic imaging might be indicated?
- Duplex US
- Cavernosography
- Arteriography
- Penile nocturnal detumescence study
What is first-line managment for psychogenic ED?
- Sex therapy
- Stress reduction
What are the pharmacologic treatments for ED?
- Oral PDE-5 inhibitors
- Injection therapy
- Testosterone replacement therapy
When is testosterone replacement therapy useful for ED?
- Documented hypogonadism
- Low testosterone levels
What kind of patient should we be extremely cautionary of giving testosterone to?
Prostate issues
It is a prostate GROWTH factor
What are the preferred forms of testosterone replacement?
- Transdermal
- IM injections
Both are cheap and provide stable levels of testosterone.
Describe the frequency of testosterone monitoring.
- Measure 2-3 months after starting or changing dose.
- 6-12 months for maintenance.
- Midway for injections, anytime for daily.
What are the primary DDIs for testosterone?
- Warfarin
- GnRH agonists/antagonists
- Steroids
What is the MOA of a PDE-5 inhibitor?
Degradation of cGMP, which allows sustained inflow to the penis.
First-line treatment for most patients.
Similar efficacy, but patient response varies a lot.
What are the 4 hour PDE-5 inhibitors?
- Sildenafil (1 hour prior NPO)
- Vardenafil (1 hour prior NPO)
- Avanafil (30 mins prior)
Vardenafil has an ODT form.
