Erectile Dysfunction
on
4.6.08
with
0 comments
You are here: Home » Anatomy Notes , Medicine Notes , Neurology notes , Pharmacology Notes , Psychiatry Notes , Surgery Notes » Erectile Dysfunction
Pathophysiology
ED is essentially a vascular disease often associated with diabetes, hypertension, and CAD. Other conditions include neurologic disorders, endocrinopathies, BPH, and depression.
Conditions associated with reduced nerve and endothelium function, such as aging, smoking, and hypercholesterolemia cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. Sexual dysfunction may be the presenting symptom of these disorders.
ED is often an adverse effect of many commonly prescribed medications such as psychotropic and antihypertensive agents.
Frequency
In the Massachusetts Male Aging Study (MMAS), a community-based survey of men aged 40-70 years, 52% of the respondents reported some degree of erectile difficulty. Complete ED, defined as (1) the total inability to obtain or maintain an erection during sexual stimulation and (2) the absence of nocturnal erections, occurred in 10% of the respondents. Lesser degrees of mild and moderate ED occurred in 17% and 25% of responders, respectively.
An estimated 18-30 million men in the US are affected by ED. Long-term predictions based on an aging population suggest a large increase in the number of men with ED.
Causes
ED is divided into organic and psychogenic impotence, but most men with organic etiologies usually have an associated psychogenic component. Pure psychogenic ED is an uncommon disorder.
Diabetes is a well-recognized risk factor, with approximately 50% of diabetic men experiencing ED.
Cigarette smoking has been shown to be an independent risk factor, increased by a factor of 1.5
A sedentary lifestyle is a contributing factor to ED. Exercise has a beneficial effect on the cardiovascular system, and men who exercise regularly have a lower risk of ED.
Vascular diseases account for nearly half of all cases of ED in men older than 50 years. Vascular diseases include atherosclerosis, peripheral vascular disease, myocardial infarction, and HTN.
| Medication | Advantages | Disadvantages |
| Hormonal (testosterone) therapy | May restore sexual desire | Useful only in the few patients with abnormal hormone levels |
| Vasodilators (nitroglycerine) | Painless | No reports on long-term use |
| Yohimbine (Yocon) | Adverse effects uncommon | Need to take medication every day |
| Pentoxifylline (Trental) | Adverse effects uncommon | Adverse effects, including headache, dizziness, and stomach upset |
| Trazodone (Desyrel) | Adverse effects uncommon | No reports proving benefit |
| Intraurethral pellet therapy (MUSE) | May use treatment only when desired | Pellet must be inserted directly into penis through urethra |
1. Andersson KE: Erectile physiological and pathophysiological pathways involved in erectile dysfunction. J Urol 2003 Aug; 170(2 Pt 2): S6-13
2. Burnett AL: Erectile dysfunction: a practical approach for primary care. Geriatrics 1998 Feb; 53(2): 34-5, 39-40, 46-8
3. Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999 Feb 10; 281(6): 537-44
Category: Anatomy Notes , Medicine Notes , Neurology notes , Pharmacology Notes , Psychiatry Notes , Surgery Notes
Subscribe to:
Post Comments (Atom)
POST COMMENT
0 comments:
Post a Comment