what is ED?
consistent or recurrent inability of a man to acheive/maintain an erection to receive sufficient satisfaction in sexual intercourse
what is intimacy
quality of two people in a romantic relationship
may or may not be sexual
what is sensuality
experiencing pleasure from senses leading to increased awareness of appreciating someone’s body
what is sexuality
combo of:
sexual behaviour
sensual activity
emotional intimacy
sense of sexual identity
what is impotence
stigmatized
inability of a man to perform a sexual act
how common is ED?
1 in 2 men will experience it in their lifetime
strongest predictor of ED
age
as age increases, ED increases
why does ED happen as men age/
takes longer to get aroused
longer climax
weaker orgasms
prolonged plateau
prolonged refractory period in older men
risk factors for ED
cigarette smoking (endothelial changes in penis)
sedentary lifestyle
alcohol chronically
riding bikes for long times
shift work
diet
air pollution
pesticides
heavy metals
stress
anxiety
misinformation
social media
porn
which diseases are risk factors for ED
CVD - HTN, CAD, stroke, high cholesterol
endocrine - DM, hypogonadism, obesity
neurology - depression, MS, Alzheimers, Parkinson’s, spinal cord/nerve injury, stroke
respiratory - COPD, Sleep apnea
periodontitis
HIV
trauma
radiation therapy
renal failure
hepatic failure
LUTS/BPH
COVID
why does high cholesterol lead to ED
penile arteries are small
so when cholesterol builds up in the arteries and makes them even more narrow, it is harder for blood flow to get to penis and cause erection
vascular disease manifests as…?
ED 2-3 years before angina or other CV sx
a man with ED is considered what?
a cardiac patient also
which CV meds cause ED
thiazides –> switch to ACEi/ARB/CCB
centrally acting BB
spironolactone
amiodarone
which hormone therapy causes ED
steroids
estrogens
progestins
GnRH agonists
finasteride
which psych drugs cause ED
antidepressants - SSRI/SNRI/MAOi/TCA
trazodone
clonidine –> switch to bupropion/mirtazapine/vortioxetine
risperidone -> switch to 2nd gen anti psychs
lithium
which anticonvulsants cause ED
phenytoin
gabapentin
which drugs causing SUD cause ED
tobacco
heroin
cocaine
alcohol
opioids
which analgesics cause ED
high dose and chronic use
NSAIDs
opioids
how does an ED occur
interaction bw CNS/PNS/vascular system
and muscle of penis
in a flaccid penis, arterial and smooth muscle are contracted and sympathetic system is activated –> minimal blood flow to penis
how does an erection occur
STIMULI IS REQUIRED
PNS gets activated
nitric oxide is released
cyclic GMP is activated and calcium decreases in the cells
this causes penis to relax which allows more blood into penis leading to a increased pressure compressing the veins in the penis
blood does not flow out (low venous outflow)
what are the types of ED
failure to :
initiate
fill
store volume
what is failure to initiate?
neurogenic/psych
can’t trigger an erection
causes: anxiety/MDD, nerve injury
what is failure to fill?
more common
ateriogenic/vascular
inadequate blood inflow to corpora cavernosa
causes: atherosclerosis, HTN, endothelial dysfunction, DM, smoking
any bit of blockage to penile arteries makes a big impact
