Erectile Dysfunction

Question 1

What is the definition of erectile dysfunction?

Answer 1

Inability to achieve or maintain an erection sufficient enought for sexual performance

Question 2

What are the risk factors for erectile dysfunction?

Answer 2

Organic cause - CV disease, hypertension, hyperlipidaemia, PAD, diabetes mellitus, smoking, neurological, endocrine, alcohol
Psychogenic - stress, anxiety, depression
Medications - Antihypertensives, diuretics, antidepressants, recreational drugs.

Question 3

What are factors that indicate an organic cause for erectile dysfunction?

Answer 3

• Gradual onset of symptoms,
• Lack of tumescence,
• Normal libido

Question 4

Factors favouring a psychogenic cause

Answer 4

• Sudden onset,
• Decreased libido
• Normal sponataneous or self stimulated erections,
• Major life events,
• Relationship problems,
• History of premature ejaculation

Question 5

What are the investigations for erectile dysfunction?

Answer 5

• 10 year cardiovascular risk should be calculated by measuring lipids and fasting glucose.
• Free testosterone should be measured between 9-11am. If low then look at LH and FSH
• HbA1c

Question 6

What is the management of erectile dysfunction?

Answer 6

• Phosphodiesterase-5 inhibitors (PDE5 inhibitors) eg, sildenfil or tadalafil. 50mg an hour before sexual activity for sildenafil.
• Young men who have always had difficulty should be referred to urology,
• Consider psychosexual therapy

Question 7

What are the contraindications for PDE5 inhibitors

Answer 7

Use of organic nitrates, severe cardiovascular disease, recent MI or strokes, heart failure, angina, hypertension

Question 8

What is priapism?

Answer 8

Painful, prolonged erection for more than four hours.

Question 9

What are the side effects of PDE-5 inhibitors?

Answer 9

• Headaches, flushing, dyspepsia, nasal congestion, back pain and myalgia

Question 10

What are the drug interactions with PDE-5 inhibitors?

Answer 10

• Nitrates
• Alpha blockers