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Erectile dysfunction

Medicine > Cardiovascular

Background knowledge 🧠

Definition

  • Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.
  • Also known as impotence.
  • Can be a chronic condition or occur intermittently.
  • Affects men of all ages but more common in older men.

Epidemiology

  • Prevalence increases with age.
  • Approximately 50% of men aged 40-70 experience some degree of ED.
  • Higher incidence in men with comorbid conditions (diabetes, cardiovascular disease).
  • Lifestyle factors (smoking, alcohol, obesity) contribute to risk.

Aetiology and pathophysiology

  • Vascular causes: atherosclerosis, hypertension.
  • Neurological causes: spinal cord injury, multiple sclerosis.
  • Endocrine causes: diabetes mellitus, hypogonadism.
  • Psychogenic causes: anxiety, depression, stress.
  • Medications: antihypertensives, antidepressants.
  • Pathophysiology involves impaired blood flow, nerve function, or hormonal regulation.

Types

  • Primary: lifelong condition, often due to psychological factors.
  • Secondary: acquired later in life, often due to physical causes.
  • Situational: occurs in specific situations, often psychogenic.
  • Organic: due to physiological factors (vascular, neurogenic, hormonal).
  • Mixed: combination of organic and psychogenic factors.

Clinical Features 🌡️

Symptoms

  • Difficulty achieving or maintaining an erection.
  • Reduced sexual desire or libido.
  • Erections that are not firm enough for penetration.
  • Erections that last for a short duration.
  • Psychological distress related to sexual performance.
  • Possible concurrent symptoms of underlying conditions (e.g., angina).

Signs

  • Physical examination may be normal.
  • Signs of underlying conditions (hypertension, diabetes).
  • Penile abnormalities (Peyronie’s disease).
  • Diminished peripheral pulses indicating vascular disease.
  • Gynecomastia or small testes in hormonal causes.

Investigations 🧪

Tests

  • Blood tests: glucose, lipid profile, testosterone, prolactin.
  • Nocturnal penile tumescence testing to differentiate between psychogenic and organic causes.
  • Doppler ultrasound of penile vessels.
  • Psychological assessment if psychogenic ED is suspected.
  • Neurological tests if neuropathy is suspected.
  • Cardiovascular assessment in patients with risk factors.

Management 🥼

Management

  • Lifestyle changes: weight loss, smoking cessation, reducing alcohol intake.
  • Phosphodiesterase type 5 inhibitors (sildenafil, tadalafil).
  • Hormone therapy if hypogonadism is diagnosed.
  • Psychotherapy or counseling for psychogenic causes.
  • Vacuum erection devices or penile implants for refractory cases.
  • Addressing underlying conditions (diabetes, hypertension).

Complications

  • Relationship difficulties and reduced quality of life.
  • Low self-esteem and depression.
  • Potential indicator of cardiovascular disease.
  • Adverse effects from medications (headaches, flushing).
  • Priapism (rare, with certain treatments).

Prognosis

  • Varies depending on underlying cause and treatment adherence.
  • Generally good with appropriate management.
  • Chronic conditions may require ongoing treatment.
  • Lifestyle modifications can significantly improve outcomes.
  • Early intervention improves prognosis.

Key points

  • A common condition with multifactorial aetiology.
  • Comprehensive assessment is essential to identify underlying causes.
  • Management includes lifestyle changes, pharmacotherapy, and addressing psychological factors.
  • Regular follow-up and patient education are important for long-term management.
  • Early diagnosis and treatment can improve quality of life and overall prognosis.

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Cardiovascular