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11 Cards in this Set
- Front
- Back
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What is Erectile dysfunction?
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Persistent inability to attain or maintain erection for sexual intercourse
1/3 men over 40 - increases with age Trabeculae and vascular smooth muscle relaxation required for erection NO (from nerves & endothelial cells) stimulates production cGMP - relaxation - terminated by PDE5 PGE1 also causes relaxation Dopamine in hypothalamus (via D2) important in initating reaction. |
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What are the causes of erectile dysfunction?
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Psychogenic - depression, psychosis, stress etc
Neurogenic - MS, spinal cord injuries, diabetic neuropathy etc Vascular - pudendal or internal iliac artery disease Metabolic - diabetes, HT, smoking, hyperlipidaemia Hormonal - hypo & hyper-thyroidism, hypogonadism, hyperprolactinaemia Drugs - anti-HT, anti-depressants, anti-psychotics, anti -andogens, statins, OH, other drugs Anatomical - Peyronie d, injection fibrosis etc |
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What is the management of erectile dysfunction?
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1. Clinical assessment to establish diagnosis and cuases
2. Treat reversible causes 3. First line treatment (vaccuum constriction device, oral therapy - PDE5 inhibitor or dopamine D2 agonist 4. Second line treatment - Intracavernosal injection PGE1, drug mixtures, urethral applications 5. Third line - surgical (penile implant, other) |
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What is amenorrhoea?
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Primary - 16+ (or 2 years after breast delopment) RARE
SEcondary - absent menses 6+ months COMMON Normal cycle 21-36 days Oligo >36 days to 6 months |
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What are the causes of primary amenorrhoea?
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Delayed puberty - growth rate & bone age
Hypothalamic - stress, exercise, LOW, decreaesd FSH/LH Gonadal dysgenesis - increased FSH/LH Congenital outflow obstruction - Ultrasound Other - e.g. androgen insensitivity (decreased axillary/pubic hair) |
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What are causes of secondary amenorrhoea?
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Pregnancy
Lactation Hyperprolactinemia - adenoma, drugs Hypothalamic - stress, exercise, dieting, anorexia Endocrinopathies - thyrotoxicosis, Cusings Addisons Polycystic ovarian syndrome - 6-9% population Premature ovarian failure/menopause Iatrogenic - long acting progestins Endometrial pathology - rare |
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What investigations are done for amenorrhoea?
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HCG - ALWAYS
Prolactin LH, FSH, oestrogen TFTs Chromosomal analysis Pelvic ultrasound Androgens (hydroepiandrosterone etc) MRI/CT pituitary |
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What are the female causes of infertility?
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Ovulatory dysfunction/hormonal
Oocyte ageing Tubal pathology Other pelvic pathology including endometriosis Uterine/cervical pathology Coital difficulty Unexplained |
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What are the male causes of infertility?
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Hormonal
Sperm production Obstruction to sperm Sperm antibodies Sexual problems - Ejaculatory/coital dysfunction Unexplained |
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What investigations are done in the female for infertility?
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Cervical mucus changes/Temperature (not accurate)
Mid-luteal serum progesterone (7 days before period expected - problem of timing) FSH, LH, androgens, SHBG, prolactin, TSH Pelvic ultrasound Sono-hysterogram Hysteroscopy/laparoscopy with tubal dye hydrodilation |
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What investigations are done in the male for infertility?
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Semen analysis including pH, sperm ABs
Sperm-mucus penetration test Sperm-function tests (research) |
