erectile dysfunction +ejaculatory disorders

define erectile dysfunction

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

ED has an association with… (2)

CVD, Diabetes

how does an erection occur

sexual arousal = release of NO from neurone synapses in corpus cavernosum in penis = accumulation of cGMP = smooth muscle relaxation = inflow of blood to the corpus cavernosum = erection

do you refer to psychosexual or relationship therapy for ED?

yes- even though the psychogenic part of ED causes is only 20%

how can antipsychotics lead to ED

due to the blockade of D2 receptor in tuberoinfundibular pathway = elevated prolactin levels (olanzapine, risperidone, haloperidol)

how can steroids cause ED

lower testosterone

how do 5alpha reductase inhibitors cause ED

inhibit conversion of testosterone to dihydrotestosterone = induction of androgen deficiency + BPH

how do we get an objective score for ED

SHIM, sexual health inventory for men

what are the 2 phases of ejaculation called

emission, expulsion

what system mediates ejaculation

autonomic nervous system

premature ejaculation is the ______ disorder

most common

what is the difference between primary premature ejaculation and secondary premature ejaculation

primary is lifelong and started when they become sexually active, secondary is acquired, occurs within 3 mins of penetration

what is anejacultion

complete absence of ejaculation

what are some causes of anejaculation

interruption of neural pathways of ejaculation eg. Spinal cord injury, DM with peripheral neuropathy, MS, structural or medication induced

treatment of anejaculation

counselling, sperm retrieval if desire to become pregnant

what is retrograde ejaculation

semen passes backwards into the bladder, bladder neck fails to close in expulsive phase

what are some causes of retrograde ejaculation

surgery, neurogenic disruptors, medication, mechanical disruption of bladder neck

treatment for retrograde ejaculation

sympathomimetic agents eg. imipramine, pseudoephedrine, midodrine and sperm retrieval if trying to get pregnant, sperm can be retrieved from urine