Erectile Dysfunction PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lect...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins Erectile Dysfunction  Erectile Dysfunction Pathophysiology Inability to achieve or maintain an erection sufficient for satisfactory sexual performance 150 million men worldwide Cause: Psychogenic Organic Both ED is now considered a marker for cardiovascular disease Component of metabolic syndrome  Erectile Dysfunction Pathophysiology Related to problems with one or more of the following: Arousal Parasympathetic nervous stimulation (S2-4) Arterial dilation, increased blood flow Smooth muscle relaxation of corpora cavernosa Sinusoids enlarge Compress veins, venous occlusion occur, blood is trapped (Erection reversed under sympathetic influence) Facilitation by androgen activity on hypothalamus and anterior pituitary Braun CA, Anderson CM. Pathophysiology: a clinical approach. 2nd ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins;2011  Erectile Dysfunction Clinical Manifestations Inability to achieve and maintain erection Other clinical manifestations dependent upon cause Hormonal factors: hypogonadism, hypothyroidism, or adrenal cortical hormone dysfunction inadequate hormonal “priming” of the sexual centers of the brain Neurological factors: spinal cord or perineal nerve injury inadequate nerve signaling to the penile vessels Psychological factors: anxiety, low self-esteem, or depression inadequate arousal Vascular obstruction: hypertension, atherosclerosis, vascular obstruction, and smoking disallow blood flow to the corpora cavernosa and spongiosa preventing erection from occurring Impaired veno-occlusive ability: the inability to trap blood within the corpora cavernosa Certain medications: such as antihypertensives, can inhibit hormone and erectile function  Erectile Dysfunction Diagnostic Criteria History and physical examination Medical Sexual Psychosocial (drug use, alcohol) Identify cause Serum hormone level measurement Testosterone LH Thyroid Prolactin  Erectile Dysfunction Treatment Individualized and dependent on etiology Physical Psychological Both Psychosocial support: mental health professional Pharmacologic treatment Smooth muscle relaxation and vascular congestion in corpora cavernosa Maintain erection Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra) Penile implants to help maintain erection Porth C. Pathophysiology : concepts of altered health states. 7th ed. Philadelphia, Lippincott Williams & Wilkins; 2005.