Erectile dysfunction ED

• History / PE:
  Evaluate for neurologic dysfuction (eg. anal tone, LE sensation) and hypogonadism
• Diagnosis:
  Abnormal testosterone and gonadotrophin
  
  Check prolactin levels (elevated prolactin can result in decreased androgen activity)
  
  Nocturnal penile tumescence (helps distinguish psychogenic ED from organic ED)
• Treatment:
  Sildenafil (viagra), vardenafil (levitra), tadalafil (cialis)
  Testosterone
• Pneumonic:
  "P oint and S hoot"
  P arasympathetics mediate erection
  S ympathetics mediate ejaculation
• Notes:
  ED drugs
  Phosphodiesterase-5 (PDE5) inhibitors, result in prolonged action of cGMP-mediated smooth muscle relaxation and increased blood flow in the corpora cavernosa
  
  Do NOT combine with nitrates (severe hypotension)
  
  Take alpha blockers and ED meds 4-6 hours apart
• Risk Factors:
  Diabetes mellitus
  Atherosclerosis
  Medications (beta blockers, SSRIs, TCAs, diuretics)