Sexual Dysfunction

Question 1

How do erections occur?

Answer 1

• Neuronal release of nitric oxide (NO)
• Via cGMP and Ca
• Hyperpolarizes and relaxes vascular and trabecular smooth muscle cells
• Allows for engorgement

Question 2

Erectile dysfunction is common after 50 years and often is multifactorial.

What are the biggest 3 causes of erectile dysfunction?

Answer 2

• Smoking
• Alcohol
• Diabetes

Question 3

What are other causes of ED?

Answer 3

• Endo → hypogonadism / hyperthyroid / hyperprolactinaemia
• Neuro → cord lesions / MS / autonomic neuropathy
• Pelvic surgery
• Radiotherapy
• Renal or hepatic failure
• Prostatic failure
• Drugs → digoxin / beta-blockers / diuretics / antipsychotics / antidepressants

Question 4

What investigations are done for erectile dysfunction?

Answer 4

• Full sexual and psychological history
• Bloods → U+Es / LFT / Glucose / TFT / LH / FSH / Lipids / Testosterone / Prolactin

Question 5

What is the management of sexual dysfunction?

Answer 5

• Treat causes
• Counselling if psychological
• Oral phosphodiesterase (PDE5) inhibitors (eg. Sildenafil)
  
  • ↑cGMP
  • 25-100mg 30mins-1hr before sex, food and alcohol upset absorption
  • SE → headache / flushing / dyspepsia / stuffy nose
  • CI → BP high or systolic < 90 mmHg / unstable angina or stroke < 6m ago / MI < 90d ago

Question 6

What is male hypogonadism?

Answer 6

Failure of testes to produce testosterone, sperm or both

Question 7

What are clinical features of male hypogonadism?

Answer 7

• Small testes
• Reduced libido
• Erectile dysfunction
• Loss of pubic hair
• Reduced muscle bulk
• Gynaecomastia
• Osteoporosis
• Reduced mood
• If prepubertal → reduced virilsation / incompl puberty / eunuchoid body

Question 8

Primary hypogonadism is testicular failure.

What are causes of primary hypogonadism?

Answer 8

• Local trauma
• Torsion
• Chemotherapy / Irradiation
• Post-orchitis (eg. Mumps)
• Renal failure
• Liver cirrhosis or alcohol XS
• Klinefelter’s syndrome (47 XXY)

Question 9

Secondary hypogonadism involves reduced gonadotrophins.

What are causes of secondary hypogonadism?

Answer 9

• Hypopituitarism
• Prolactinoma
• Kallman’s syndrome
• Systemic illness (eg COPD)
• Prader-Willi syndromes
• Age

Question 10

Klinefelter syndrome (sometimes called Klinefelter’s, KS or XXY) is where boys and men are born with an extra X chromosome.

What are clinical features of Klinefelter syndrome?

Answer 10

• Often taller than average
• Lack of 2 sexual characteristics
• Small, firm testes
• Infertile
• Gynaecomastia
• Elevated gonadotrophins