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Impotence / Erectile Dysfunction

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Topic updated on 04/29/15 12:41am

Snap Shot
  • A 65-year-old man with a history of alcoholism, tobacco, and hypertension presents to the urology clinic with complaints of erectile dysfunction.
Introduction
  • The failure to sustain an erection during attempted intercourse
  • Common disease
    • 30 million Americans
    • 40% of males at 40
    • 70% of males at 70
  • May be primary or secondary
    • primary erectile dysfunction
      • inability despite a normal functioning penis
      • etiologies include
        • psychogenic
          • fear of intimacy, depression, stress, anxiety, and guilt
        • ↓ testosterone
          • seen as libido/desire
        • hyper and hypothyroidism
        • Cushing's syndrome
    • secondary erectile dysfunction
      • abnormal functioning penis
      • etiologies include
        • vascular disease
          • atherosclerotic disease with blood flow to penis
        • diabetes
          • combination of vascular disease + neurologic disease
        • drugs
          • alcohol, diuretics, clonidine, CNS depressants, and antidepressants
        • neurologic (abnormal nerve supply to the penis)
          • stroke and temporal lobe seizures

Evaluation
  • Diagnosis is clinical
  • Nocturnal penile tumescence (NPT)
    • erections that occur at night
    • man with psychologic cause will still have NPT
Treatment
  • Medical
    • sildenafil 
    • yohimbine
      • herbal therapy
      • results in vasodilation of penal vessels
    • testosterone therapy
      • used in cases of hypogonadism


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