Sexual Dysfunction And Reproductive Disorders

Question 1

What is causing ED if it is random and infrequent

Answer 1

Psychological
Depress, anxiety, stress

Question 2

How to avoid ED long term

Answer 2

Frequent erections promote subsequent erectile potency
frequent ejaculations improve sperm quality and decrease risks of prostate cancer

Question 3

When is ED more common in men

Answer 3

Sex less than once a week

Question 4

% of males confident in erection in 40s and at old ages

Answer 4

60% in 40s
7% at old age

Question 5

Changes in sperm with age. Provide age range

Answer 5

Decrease in semen volume (3-22%)
Impaired sperm motility (3-35%)
Impaired sperm morphology (4-18%)
Due in part to decreasing T with age
Start age 30-50 yrs

Question 6

Medical evaluation of ED

Answer 6

Libido- sex drive (low T, mental health, steroid use)
Injury- nerve
Medication- depressant (benzodiazepine)
Present medical condition- atherosclerosis, cancer

Prostate- cancer
Erection at all- still have nocturnal ejaculation (wet dreams)
Nocturnal or morning erection
Incontinence- lack of bladder control
Stress/depression- mental health

Question 7

Different interventions to stop ED

Answer 7

Surgery- vascular reconstruction, penile prosthesis/implant (penis pump)
Devices- pump, ring
Behavioural therapy
Reversible causes- medications, smoking (cannabis, cocaine), alcohol
Pharmacology- PDE5 inhibitor (Sildenafil), injection therapy (prostaglandins), MUSE (suppository with prostaglandins for urethra), testosterone (controversial- inhibit HPA axis)

Question 8

Factors causing erectile dysfunction

Answer 8

Psychogenic- traumatic experiences, depression, anxiety, major life events, relationship problems
Vascular/endothelial- atherosclerosis, hypertension, dyslipidemia, smoking
Neurological- CNS= SCI, MS, brain injury. PNS= neuropathy, diabetes. Efferent= pelvic surgery
Penile factors- cavernous fibrosis (replace VSM with harder, not able to relax/constrict the same), age related changes
Endocrine- diabetes (lead to peripheral vascular damage), hypogonadism
Drug induced- recreational, psychotropic, anti-HTN, anti-androgenic
General health- CVD, aging, obesity, sedentary

Question 9

What is the first line of treatment for ED

Answer 9

PDE5 inhibitors

Question 10

Three types of ejaculatory dysfunction

Answer 10

Premature/early ejaculation (75%)
- 1 min ejaculation after sustained penetration
- associated with ED (lose erection quick because ejaculate fast)
- to fix: sex therapy, PDE5 inhibitors, local anaesthetic cream with condom (lidocaine), more practice

Delayed ejaculation/anejaculation
- caused by nerve damage (para or symp)
- associated with pudendal neuropathy
- to fix: sex therapy (if mental), correct reversible cause partaking in, drugs (vasodiazepam)

Retrograde ejaculation
- dry orgasm caused by impairments to bladder sphincter (normally will contract during arousal and ejaculation)
- associated with TURP, diabetic neuropathy, SCI
- sperm can be retrieved for fertility treatments (IVF)

Question 11

What is cryptorchidism who does it effect

Answer 11

When testes don’t descend
3% full term babies
30% premature babies
Most will descend in first month

Question 12

If testicles don’t descend on there own, what age should surgery be done? What are the associated risks with this condition

Answer 12

Cryptorchidism
Surgery early- 1 year
Strong benefit before 13 years
Associated with increased risk of testicular cancer (4-40 fold) and infertility (10-40%)

Question 13

D2:D4 ratio in cryptorchidism

Answer 13

D2<D4 (lower ratio)
Higher T in utero
This high T seems to play a role in hindering development, maybe causing a decreased sensitivity to T

Question 14

What maternal exposure can play a role in cryptorchidism

Answer 14

Endocrine disruptors (estrogenic or anti-androgenic)
- PDBE is an endocrine disrupter in flame retardant chemicals
(Newborn babies tested for endocrine disruptors)

Question 15

What is PDBE

Answer 15

Endocrine disruptor in flame retardant chemicals (textiles, water bottles, plastics)

Question 16

How are ovarian cysts caused

Answer 16

Lack of follicular development
Anovulation- egg doesn’t release from ovary

Question 17

What is PCOS

Answer 17

Polycystic ovarian syndrome
Frequent large cysts in ovaries
High androgen
Anovulation
Amenorrhea- no period

Question 18

What condition can cause an individual to be more susceptible to PCOS. Briefly explain pathway

Answer 18

Diabetes
Hyperinsulinaemia
- increase androgen precursors and frequency GnRH pulses
- GnRH increases LH and decreases FSH while androgen produce excessive testosterone
- LH - theca cells - testosterone
- FSH - granulosa cells - follicles fail to mature “cysts”
- both create diff symptoms
- testosterone converted to estrogen via aromatase - negative feedback on FSH by estrogen
- adiposity is a source of aromatase and is insulin resistant

Question 19

How to stop PCOS from happening

Answer 19

First- Exercise and weight reduction (adiposity - aromatase)
On insulin ppl
- OCP (oral contraceptive pills) increase SHBP (sex hormone binding protein) - inhibit testosterone
- clomid inhibit estrogen negative feedback of FSH
- metformin increase insulin sensitivity therefore less resistance

Question 20

What is primary vs secondary amenorrhea

Answer 20

Primary- absence of menstruation by 16
- Turner’s syndrome
- aromatase deficiency

Secondary- more than three months without menstruation
- hormonal imbalance, premature menopause
- pregnancy, lactation
- PCOS
- low weight, eating disorder, high athleticism

Question 21

What issues does an individual with relative energy deficiency in sports (RED-S) aka Athlete Triad have

Answer 21

• amenorrhea (if female)
• low adiposity, low energy available- possible eating disorder
• lean body mass, low weight
• absence of E2 which is needed for bone growth and maintenance (increase likelihood of osteoporosis)

Question 22

What is endometriosis

Answer 22

Presence of endometrial tissue on other pelvic organs
- endometrium lining moves up into uterine tubes and pours out
- can prevent ovulation or occlude fallopian tubes
- thickens and bleeds with menstruation cycle
- endometriomas can form (associated scarring and adhesion)
- extreme pelvic pain during menstruation and sex
- voiding bladder and bowel (muscle issues)