1. Introduction to Psychosexual Medicine
Doctor Gillian Vanhegan
Member of the Institute of Psychosexual Medicine

2. Session Four Male Problems Incidence of ED Physical causes
Psychological causes
Medical treatment
Surgical treatment
Psychodynamic therapy

3. Erectile Dysfunction
Persistent inability to attain and or maintain an erection sufficient for sexual performance
ED has a significant impact on the quality of life for patients and their partners

4. Massachusetts Male Ageing Study
In men aged 40 to 70 years (1290 subjects in study) 52% had ED
10% seek or receive treatment

5. Organic causes Vascular Neurogenic Hormonal Penile injury or disease
Medications

6. Underlying diseases 68% of men with hypertension have ED
60% of men with ED have dyslipidaemia
20% of men with ED have Diabetes
11% of men with ED have depression

7. Psychogenic causes Depression Performance anxiety
Relationship problems
Psychosocial problems
Psychological distress

8. Differences between organic and psychogenic
Masturbation
Early morning erections
Nocturnal erections
Situational ED

9. The Erection
Complex neurovascular phenomenon, which is under hormonal control
Arterial dilation
Trabecular smooth muscle relaxation
Activation of corporeal venous occlusive mechanism

10. Physical treatments First Line = PDE5 inhibitors Sildenafil (Viagra)
Tadenafil (Cialis)
Vardenafil (Levitra)
Followed by vacuum devices

11. PDE5 Inhibitors
They inhibit the degradation of cyclic GMP to enhance smooth muscle relaxation, thus allowing increased blood flow to the penis
Side –effects are flushing, headache and disturbance of colour vision
Contraindication: Nitrates

12. Physical treatments
Second Line = Intracavernosal injection, or intraurethral Alprostadil
Third Line = Penile prosthesis or implant

13. Physical Treatment for PE
SSRIs, Dapoxetine
Local Anaesthetic in condoms, such as ‘Performa condoms’
Squeeze technique

14. Psychogenic causes
Younger men, nervousness and performance anxiety. Cultural or religious influences. Possible sexual bullying or abuse.
Older men, midlife relationship problems, redundancy and loss of self esteem, competition from younger men.

15. Next Session
Female Problems
Pain with sex
Vulvodynia
Vaginismus