Male Erectile Dysfunction
Consistent or recurrent of am to attain and/or maintain a penile erection suffection for sexual activity.
Normal: 48%, minimal 17%, moderate x, minimal 10%
By age 40, 40%
Causes and risk factors
Basically, the same risk factors for cardiovascular disease would affect ED. In some way it could be considered a risk marker.
age, hypertension, hypercholesterolemia, dibetes mellitus, metabolic syndrome, depression, benign prostatic hyperplasia, lifestyle factors BMI, smoking
pathophysiology
Vasculogenic
neurogenic
structural
endocrinilogic
drug-induced
psychogenic
mixed
ED can be a risk factor for CVD, thrombosis
Investigations
"Are you having any problems with your erections?"
good morning erections suggest the anatomy is ok.
history
examination:
look for testicularl atrophy
lab: lipids, glucose, testosterone
treatments
counseling, reassurance, oral
PDE5 inhibitors: very expensive (13$ each); try samples and try 6-8 times.
- no evidence of cardiovascular risk factors; in fact, was developed for CHF, and could be cardioprotective
- success rate of 65-70%