ED 3.2

Question 1

What is definition for ED?

Answer 1

Persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance

> no universal criteria

> occasional episodes ok

> recurrence/persistence (>3 months) = reasonable guide

Question 2

What is ED associated with?

Answer 2

Cardiovascular disease and diabetes

> “Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors”

Question 3

What is the mechanism of an erection?

Answer 3

• Sexual arousal
• Release of NO from neurone synapses in corpus carvenosum of penis
• Accumulation of cyclic guanosine monophosphate (cGMP)
• Smooth muscle relaxation
• Inflow of blood to the corpus carvenosum
• Erection

Question 4

What are some vascular causes of ED?

Answer 4

• Atherosclerosis, PVD, MI
• Hypertension, dyslipidaemia
• Vascular injury
• Blood vessel and nerve trauma

Question 5

What systemic diseases can cause ED?

Answer 5

• Respiratory –> COPD and sleep apnoea
• Endocrine –> hyper/hypothyroidism, hypogonadism, DM
• Renal/liver failure
• Cancer

Question 6

What neurological conditions causes ED?

Answer 6

• Epilepsy, stroke
• MS, Guillain-Barre syndrome
• Alzheimers disease

Question 7

What psychiatric conditions cause ED?

Answer 7

Depression

Performance anxiety

PTSD

> surgery, medications, drug/alcohol alll can contribute also

Question 8

What are some risk factors for ED? Include a comprehensive list of medications that do also please.

Answer 8

Increasing age

Some clinical conditions

Smoking

Medications

• Antihypertensives
• Antidepressants (SSRIs)
• Antipsychotics (olanzapine and risperidone)
• H2As
• 5-alpha-reductase inhibitors = reduce testosterone
• Gemfibrozil
• Methadone
• Hormones
• Cytotoxic agents
• Immunomodulators
• Anticholinergic agents
• Opioids
• Recreational drugs

Question 9

What need to assess and test patient for before commencing pharmacotherapy? What is sufficient cardiac fitness for sexual activity?

Answer 9

Sufficient cardiac fitness for sexual activity = climb 20 stairs in 15 seconds

rest of the answer see attached image

Question 10

What is an example of a questionaire to assess ED? What score is used?

Answer 10

5-item IIEF5 score

<22: ED

17-21: Mild ED

8-16: Moderate ED (mild to moderate 12-16)

<8: Severe ED

Question 11

How is ejaculation mediated? What are the 2 phases?

Answer 11

Mediated by autonomous nervous system

2 phases

1. Emission
2. Expulsion

Question 12

What is the pathogenesis of premature ejacualtion?

Answer 12

• Psychorelational
• Neurobiological
• Urological
• Hormonal
• Andrological

Question 13

How is premature ejaculation defined?

Answer 13

Persistent or recurrent ejaculation before, during or shortly after penetration

> intravginal ejucalatory time of <2 minutes

Question 14

2 types of premature ejaculation?

Answer 14

Primary: lifelong (from beginning of sexual experience); never had control over ejaculation

Secondary: acquired, i.e. secondary to other factors (situitational ED)

Question 15

What is anejaculation and retrograde ejaculation caused by?

Answer 15

Interruption of neural pathways of ejaculation

> autonomic neuropathies (especially in long-term diabetes)

Question 16

What is anejaculation?

Answer 16

Complete absence of ejaculation

Normal orgasmic sensation

Treatment

> counselling

> sperm retrieval techniques

Question 17

What is retrograde ejaculation? Tx?

Answer 17

Semen passes backwards into the bladder

Little or no sperm is discharged

May be secondary to prostate surgery, DM

Normal or decreased orgasmic sensation

Treatment

• Several days before semen collection or ovulation: imipramine or pseudoephedrine = helps keep bladder neck closed