Erectile dysfunction

a.k.a. Impotency

Def. Consistent or recurrent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity

Physiology

• Carvenous nerve simulation → NO → cGMP → decreased intracellular [Ca+] → SM relaxation → engorgement of penis → obstruction of emissary vein → sustained erection

Etiology (PENIS)

• P: Psychological - sudden onset
  • Anxiety, Depression
• E: Endocrine (T, prolactin)
  • Hypogonadism , Hyperprolactinemia ↑
  • Obesity , Sedation (Drowsy) → Functional hypogonadism: decreased Testosterone
• N: Neurological
• I: Insufficient blood flow (Vascular)- gradual onset
  • Diabetic Neuropathy,
  • CVD - Atherosclerosis,
  • PVD History,
  • Smoking (RF),
  • Older Adult > 65 (RF)
• S: Substances and drugs
  • SSRI/SNRI
  • Anti-psychotic (D2i)
  • Beta Blocker (”-prolol”)

Other causes:

• Pelvic surgery
• Prostate surgery

Investigation

• International Index of Erectile Function (IIEF)
• T2DM Work up → HbA1c (< 6.5)
• Lipid Profile