Introduction
Erection requires an intact parasympathetic reflex at S2 and S3.
Ejaculation requires an intact sympathetic L1 root.
Mnemonic: Erection & ejaculation = Point & Shoot (Para & Sym)
Aetiology
Organic causes
- Spinal cord or cauda equine disease
- Multiple sclerosis
- Endocrine disease
- DM
- Hypogonadism
- Hyperprolactinaemia
- Generalised vascular disease
- Trauma causing nerve or vascular disease
- Hypertension or hypertensive drugs
Psychological causes
- Depression
- Relationship problems
- Sexual orientation uncertainties
Age-related problems (>50) tend to follow a common vicious circle:
Epidemiology
- ED occurs in 52% of men aged 40-70:
- 17% have minimal ED
- 25% have moderate ED
- 10% have complete ED
Investigations
All patients should have a random plasma glucose or urinalysis for glucose to exclude diabetes. Further tests to consider include:
- Serum testosterone, prolactin, LH, sex hormone binding globulin
- TFTs
- FBC
- LFTs, gamma GT, renal function, fasting lipid profile
Treatment
Anxiety-induced ED is treated using a therapeutic regimen based:
- Sexual history
- A period of abstention for several weeks
- Onset of therapy
Pharmaceutical treatments include
- Phosphodiesterase-5 inhibitors eg. Sildenafil citrate (Viagra), tadalafil, verdenafil
- Sublingual apomorphine
- Intracavernosal injections
- Transurethral alprostadil
- External devices
- Surgery
- See more at: http://almostadoctor.co.uk/content/systems/urology/erectile-dysfunction#sthash.v99zXY0p.dpuf