ERECTILE DYSFUNCTION IN MEN

Sexuality remains an important component of social and functional status throughout the life span. It has been reported that erectile dysfunction is extremely common in males over the age of 40 years who had a concomitant medical condition. Difficulty in maintaining erections is present in 33% of younger and 68% of older men. 

A diagnostic questionnaire to identify patients with Erectile Dysfunctions.A positive questionnaire represents yes answers to  any three questions. 

1.                 Do you have a decrease in libido (sex drive)?

2.                 Do you have a lack of energy?

3.                 Do you have a decrease in strength and/or endurance?

4.                 Have you lost height?

5.                 Have you noticed a decreased “enjoyment of life”?

6.                 Are you sad and/or grumpy?

7.                 Are your erections less strong?

8.                 Have you noted a recent deterioration in your ability to play sports?

9.                 Are you falling asleep after dinner?

10.             Has there been a recent deterioration in your work performance?

Causes of Erectile Dysfunction 

VASCULAR: 

DRUGS:

HORMONAL: 

*     hyperthyroidism
*     hypothyroidism
*     hyperprolactinemia
*     diabetes mellitus 

PSYCHOGENIC:   

*     Depression
*     Relationship problems
*     Widowers syndrome
*     Performance anxiety

PENILE DISEASE:

*     Peyronie’s disease
*     Penile trauma 

NEUROGENIC:

*     autonomic neuropathy
*     pudendal neuropathy
*     spinal cord disease
*     multiple sclerosis

Investigations which are helpful in diagnosing impotence 

1. Routine physical examination

2. Complete Haematology

3. Sugar testing

4. Hormonal assays

5. Evaluation of Autonomic Nervous System

6. N.P.T. monitoring

7. E.M.G

8. Papaverine injection

9. Color Doppler examination

10. Penile blood pressure

11. Infusion Cavernosometry and Cavernosography

       Management tools for erectile dysfunction


1. Oral drugs                     

• -- Sildenafil
• -- Experimental:
  i apomorphine
  ii phentolamine
  iii endothelin antagonists
  iv second generation
  PDE5 inhibitors
  v L-arginine

2. Intracavernosal drugs

• -- alprostadil
• -- papaverine
• -- phentolamine

3. Intraurethral drugs     -- alprostadil

4. Gels 

• -- nitropaste
• -- minoxidil

5. Penile prosthesis

• -- semi-rigid
• -- inflatable

6. Psychological           

• -- treat depression
• -- couples counseling

7. Adjunctive               -- testosterone

8. Vacuum Tumescence Device