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Erectile Dysfunction

Erectile Dysfunction. Dr P A Nathan Hollybrook Medical Centre. How common?. 50% of men between 40-70yrs 70% of men aged 70yrs. History. Key Points Difficulty getting and maintaining erection Premature ejaculation Psychosocial. Causes. IHD ,hypertension, High cholesterol Diabetes

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Erectile Dysfunction

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  1. Erectile Dysfunction

    Dr P A Nathan Hollybrook Medical Centre
  2. How common? 50% of men between 40-70yrs 70% of men aged 70yrs
  3. History Key Points Difficulty getting and maintaining erection Premature ejaculation Psychosocial
  4. Causes IHD ,hypertension, High cholesterol Diabetes Neurological problems Low testosterone – previous head injury Nerve damage – pelvis Drugs Alcohol Cycling Psychological or mental health
  5. Risk factors Smoking High blood pressure Weight Inactivity Diet Alcohol Diabetes
  6. Investigations Bloods MSU Bp ECG
  7. Prescribing When was viagra available? What classification of drug? Which neurotransmitter is involved? What contra-indications are there to oral medication? What is important about alpha-blockers? How successful is this treatment? Who is at risk of prolonged erections? How is prescription endorsed?

  8. What is significant about this date?

    1 July 1999
  9. NHS criteria Diabetes, MS , Parkinson’s disease Poliomyelitis, prostate cancer , severe pelvic injury, single gene neurological disease, spina bifida, spinal cord injury Dialysis for renal failure Radical pelvic surgery, prostatectomy, renal transplant Were receiving other treatments on 14.9.1998 Suffering severe stress (specialist centre)
  10. Severe stress Significant disruption to normal social and occupational activities Marked effect on mood, behaviour , social and environmental awareness Marked effect on interpersonal relationships
  11. Side effects Dyspepsia, Vomiting Headaches Flushing Dizziness, myalgia, visual disturbances Raised intra-ocular pressure Nasal congestion hypersensitivity reasctions Priapism, Painful red eyes
  12. More prescribing Which agent? How many? Where can I get it from? Interactions
  13. Comparison
  14. What is the cost of nhs prescription? £7.85
  15. What other agents can you use? Apomorphine (uprima) Alprostadil Caverject Virdal duo MUSE
  16. Herbal alternatives? What herbal treatments are available for treating erectile dysfunction? Yohimbe – African tree bark Chinese horny goat weed Ginko Biloba Red ginseng (natural source of sildenafil)
  17. Other treatments Treat underlying condition Psychosexual counselling
  18. When to refer? Vaccum devices Penile prosthesis

  19. Any Questions?

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