Erectile dysfunction

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Erectile dysfunction

• The ins and outs
• Louise MacPherson

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Definition

• Gradual onset of inability to achieve an erection
  sufficient for penetration
• Most men have difficulty having an erection from
  time to time stress, tiredness, alcohol, not in
  the mood. If persistent and prevents normal sex
  life, disrupting relationship, depressed gt
  medical advice
• Not ejaculation problems, priapism

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How common is it?

• Increased awareness, also strong media messages
  what is normal, marketing and availability
  Viagra gt common but incorrect usage
• 1/3 ? over 50 yrs old, 52 some difficulty, 10
  with complete ED
• Age variable most strongly associated with ED.
  Ageing population increasing problem
• Risk factors age, smoking and obesity
• Increase prevalence due to DM, HTN, CVD, Anxiety
  Depression

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Aetiology

• Multifactor, 80 organic cause
• Vascular
• - uncontrolled DM, cardiac, vascular disease
• - new or complicated anti-HTN Rx
• Neurogenic
• - Spinal cord injury
• - Neurological disease (e.g. MS)
• Hormonal
• - ? testosterone, ? prolactin
• - TSH (rare cause hypothyroid)
• Organic (focal)
• - BPH
• - liver/kidney disease

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Aetiology contd.

• Anatomical excessive curvature (Peyronies
  Disease)
• Psychogenic
• - normal libido, sexual identity, recent life
  stresses, chronic EtOH
• - not hormonal
• Medication antidepressants, antihypertensives
  (ACE inhib b-blocker)

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History, examination and investigation

• History IIEF-5 erectile dysfunction survey
• - (erection but unable maintain, nocturnal
  erections, libido)
• Review medication
• Basic explanation physiology erection
• BP
• Reflexes/Basic Neurological exam
• Scrotum/penis
• Urine sample (protein, glucose)
• Bloods testosterone,prolactin, glucose,
  cholesterol, TSH
• PSA

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Treatment or referral

• Self help ? Etoh ? smoking ?stress ?weight
• Talking therapies
• Medication 3 phosphodiesterase-5 (PDE-5)
  inhibitors. Only NHS if specific medical
  condition or severe distress
• Physical vacuum device, rods and tubes
• topical meds alprostadil, papaverine
• Referral urology, neurology, endocrinology,
  counselling. Urology if PDE-5 failure
  (ineffective after 3 doses), anatomical, or
  Hx/exam suggests primary ED

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PDE-5 inhibitors

• Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil
  (Levitra)
• Contraindicated low BP, Nitrates, multidrug
  anti-HTN medication, allergies
• BMJ clinical review (2006)
• - 1 systematic 1 subsequent RCT. Vardenafil
  5,10,20 mg 1 hour before sex
• - ? rate successful intercourse measured by IIEF
  over 12/52. 20mg better than 10mg but ? S/E
• -S/E ? headache, flushing, rhinitis,
  dyspepsia

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• Specialists cavernosomotry, U/S penis,
  arteriogram

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Resources

• www.emedicine/com/med/topic3023.htm (detailed
  physiology and medication)
• www.bigonerectilehealth.com (for IIEF-5 erectile
  function questionnaire)