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11 Cards in this Set

  • Front
  • Back
What is Erectile dysfunction?
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.
What are the causes of erectile dysfunction?
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
What is the management of erectile dysfunction?
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)
What is amenorrhoea?
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
What are the causes of primary amenorrhoea?
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)
What are causes of secondary amenorrhoea?
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
What investigations are done for amenorrhoea?
LH, FSH, oestrogen

Chromosomal analysis
Pelvic ultrasound
Androgens (hydroepiandrosterone etc)
MRI/CT pituitary
What are the female causes of infertility?
Ovulatory dysfunction/hormonal
Oocyte ageing
Tubal pathology
Other pelvic pathology including endometriosis
Uterine/cervical pathology
Coital difficulty
What are the male causes of infertility?
Sperm production
Obstruction to sperm
Sperm antibodies
Sexual problems - Ejaculatory/coital dysfunction
What investigations are done in the female for infertility?
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
Hysteroscopy/laparoscopy with tubal dye hydrodilation
What investigations are done in the male for infertility?
Semen analysis including pH, sperm ABs
Sperm-mucus penetration test
Sperm-function tests (research)