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Erectile Dysfunction CKS | A4 Medicine

Erectile dysfunction ( ED ) Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.<br>

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Erectile Dysfunction CKS | A4 Medicine

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  1. Erectile Dysfunction

  2. Erectile dysfunction ( ED ) Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Very common disorder Massachusetts Male Aging Study ( MMAS ) 1987-97 an important study revealed that 52 % men ( aged 40-70 yrs ) reported erectile dysfunction Prevalence and severity ↑es with age ED is a strong predictor of CVD in particular CAD Risk factors Shares both unmodifiable and modifiable risk factors with CVD ○ diabetes ○ obesity ○ dyslipidemia ○ metabolic syndrome ○ lack of exercise○ smoking , alcohol Age Poor physical and psychological health Lower urinary tract symptoms and BPH

  3. Causes – vasculogenicGeneralised CV disease Hypertension Hyperlipidemia Diabetes Smoking Major pelvic surgery or Radiotherapy ( pelvis or retroperitoneum ) Neurogenic -Degenerative disorders -eg multiple sclerosis , Parkinson’s , multiple atrophy etc Spinal cord trauma or diseases Stroke CNS tumours Hormonal-HypogonadismHyperprolactinaemia Hyperthyroidism , Hypothyroidism Cushing’s disease Hypopituitarism following traumatic brain injury Anatomical-Eg cavernous fibrosis , Peyronie’s disease and penile fracture , micropenis , hypospadias , epispadias Psychological-Can be predisposing ( risk factors ) precipitating ( present ) or maintaining ( ongoing ) causes.

  4. History –Detailed medical and sexual history Comorbid conditions eg hypertension , peripheral vascular disease , diabetes , obesity , renal disease Sexual history should include ○ sexual orientation ○ previous and current sexual relationships ○ current emotional status ○ onset and duration of erectile problem ○ previous consultations and treatments Validated psychometric questionnaires such as ○ International Index for Erectile Function ( IIEF ) or ○ Sexual health Inventory for Men ( SHIM ) – shorter version of IIEF can be used Two question scale for depression ( if depression suspected) ○ during the past month have you often been bothered by feeling down , depressed or hopeless ? ○ during the past month have you often been bothered by little interest or pleasure in doing things ? Lifestyle including alcohol , tobacco , illicit drugs 
 Symptoms of hypogonadism – loss of libido , loss of body hair , spontaneous hot flushes Pelvic surgery , radiation , trauma Medications

  5. Contraindications- If on nitrates in any form ( risk of severe hypotension ) Who have lost sight in one eye due to non-arteritic anterior ischaemic optic neuropathy Hypotension ( systolic < 90 ) Recent stroke Unstable angina Vardenefil is CI in ○ severe hepatic impairment○ end stage renal disease patients on dialysis ○ known hereditary retinal degenerative disorders as retinitis pigmentosaSildenefil is CI in ○ severe hepatic impairment ○ hereditary degenerative disorders as PretinosaTadalafil is CI in men with ○ NYHA class2 or greater heart failure in the last 6 months ○ uncontrolled arryhtmias ○ uncontrolled hypertension Caution-CV disease LV outflow obstruction Anatomical deformation of penis ( egangulation , cavernosal fibrosis or Peyronie’s disease ) Predisposition to priapismeg ○ sickle cell disease ○ Multiple-myeloma ○ Leukaemia

  6. LINKS AND RESOURCESS Information from British Association of Urological Surgeons ( printable 7 pages ) https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Erectile%20dysfunction.pdf Urology Care Foundation – ED patient Guide- a complete patient guide- autodownload 12 pages https://www.urologyhealth.org/Documents/Product%20Store/Erectile-Dysfunction-Brochure.pdf Printable 6 pages leaflet from Sexual Advice Associationhttps://sexualadviceassociation.co.uk/wp-content/uploads/2016/02/Men-9.-Erectile-dysfunction-V4.pdf Weblink for the page https://sexualadviceassociation.co.uk/erectile-dysfunction/ 3 page information leaflet from Andrology Australia -very informative https://www.healthymale.org.au/files/resources/erectile_dysfunction_fact_sheet_healthy_male_2019.pdf International Index of Erectile Dysfunction – patient questionnaire https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/iief.pdf# The Sexual Health Inventory for Men ( SHIM ) Questionnairehttps://www.pcf.org/c/the-sexual-health-inventory-for-men-shim-questionnaire/

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