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Published byDaisy Eugenia Stewart Modified over 9 years ago
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ERECTILE DYSFUNCTION ___________________________ FOR THE GENERALIST
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ERECTILE DYSFUNCTION ___________________________ DEFINITION THE PERSISTENT INABILITY TO ACHIEVE OR MAINTAIN ERECTION SATISFACTORY FOR SEXUAL PERFORMANCE
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ERECTILE DYSFUNCTION SCOPE AND IMPACT __________________________ ERECTILE DYSFUNCTION 30 MILLION MEN IN THE USA 40% PREVALENCE AMONG MEN > 40 70% PREVALENCE AMONG MEN > 70
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Anatomy and Mechanism of Penile Erection
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Molecular Mechanism of Penile Smooth-Muscle Relaxation
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Molecular Mechanism of Penile Smooth-Muscle Contraction
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ERECTILE DYSFUNCTION HISTORY-TAKING ERECTILE DYSFUNCTION SEQUENCE DICTION ATTITUDE LEVEL OF DETAIL
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ERECTILE DYSFUNCTION HISTORY-TAKING OVERCOMING RETICENCE ERECTILE DYSFUNCTION ASSURE CONFIDENTIALITY UNIVERSALIZE EMPATHIZE
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HISTORY-TAKING USE THE PHASES OF THE SEXUAL RESPONSE CYCLE TO GUIDE YOUR INQUIRY DESIRE EXCITEMENT ORGASM RESOLUTION
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ERECTILE DYSFUNCTION HISTORY-TAKING ERECTILE DYSFUNCTION PSYCHOGENICORGANIC Onset AbruptGradual Course SelectivePersistent Degree PartialAbsolute Nocturnal or am Erection? YesNo Associated Features Psychosocial stress Organic Disease
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ERECTILE DYSFUNCTION DIAGNOSIS ERECTILE DYSFUNCTION HISTORY IS (almost) ALL PHYSICAL CONSIDER SERUM TESTOSTERONE OTHER TESTS USUALLY NOT INDICIATED
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ERECTILE DYSFUNCTION DIAGNOSIS ERECTILE DYSFUNCTION R/O HORMONAL ETIOLOGY R/O SUBSTANCE ABUSE CONSIDER PSYCHOGENIC ETIOLOGY CONSIDER MEDICATION CHANGES TRY TREATMENT
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Approach to the Diagnosis and Treatment of Erectile Dysfunction
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Molecular Mechanism of Penile Smooth-Muscle Relaxation
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PRESCRIBING
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Start with medium dose Minor side effects – headache, flushing, dyspepsia, nasal discharge, visual change Consider cost and insurance coverage
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DEATH BY VIAGRA? ________________________________ SAFETY REPORT TO FDA EXPECTED DEATHS PER SECOND HEMODYANIC STUDIES AHA GUIDELINES
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Deaths Associated with Sildenafil Therapy in the United States
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ERECTILE DYSFUNCTION Other Oral Meds ERECTILE DYSFUNCTION Yohimbine Trazodone Apomorphine Phentolamine
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Approach to the Diagnosis and Treatment of Erectile Dysfunction
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ERECTILE DYSFUNCTION Tranurethral Medication ERECTILE DYSFUNCTION Alprostadil = Muse = Prostaglandin E1 Moderate Efficacy Expensive Causes pain frequently
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ERECTILE DYSFUNCTION Mechanical Aids ERECTILE DYSFUNCTION Vacuum device Constriction rings
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ERECTILE DYSFUNCTION Intracavernosal Therapy ERECTILE DYSFUNCTION “Trimix” of alprostadil, phentolamine, papaverine Almost always efficacious Requires referral, training, careful monitoring Risk of priapism and fibrosis
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ERECTILE DYSFUNCTION Penile Prostheses ERECTILE DYSFUNCTION Effective Major surgery Expensive Significant risk of infection Usually have to be replace after 5-10 years
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Treatment Options for Men with Erectile Dysfunction
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