On October 23rd, 2014, we updated our
By continuing to use LinkedIn’s SlideShare service, you agree to the revised terms, so please take a few minutes to review them.
operative . Explain that she is not turning into a man
Depilation with wax or creams, or electrolysis (which is expensive , and time-consuming, but does work).
1:10 hydrogens help by increasing serum sex hormone-binding globulin – but always combine with a progesterone (= the Pill) to prevent excess risk of uterine neoplasia or cyproterone acetate ( an anti-androgen and progestogen ), eg up to 00 mg on days 1–11, with oestrogen on days 1–21.
Clomifene (= clomiphene) or infertility.
Virilism is rare .
It is characterized by amenorrhoea:
temporal hair recession; Hirsutism.
This condition needs further investigations for androgen secreating adrenal and ovarian tumours.
implies an abnormal amount of breast tissue in males (it may occur in normal puberty).
It is due to an increase in the oesterogen/androgen ration.
It is seen in syndromes of androgen deficiency (eg Klinefleter’s, Kallman’s).
It may result from liver disease or testicular tumours (oestrogens ↑),
or accompany hyperthyroidism .
The commonest causes are drugs:
oestrogens, especially stiboestrol
Failure in adult male to sustain adequate erection for viginal penetration .
It is common in old age.
Psychological causes are common and are more likely if impotence occurs only in some situations;
if there is a clear stress to account for the onset of the impotence, and if early morning erections occur (although these may persist at the onset of organic disease) .
Psychological causes may exacerbate organic causes.
The major organic cause is diabetes.
Other organic causes are:
Antihypertensives including diuretics and B –blockers),
testosterone (eg if libido ↓) Nocturnal tumescence studies are not usually needed if alprostadial does not induced erection, the cause is probably vasscular.
Doppler may show ↓ blood flow,
but is rarely needed as vascular reconstruction is difficult.
Mange underlying causes.
Offer counseling + vacuum aids;
alprostadil, ie prostaglandin E1 (Injection or via urethra);
or sildenafil (Viagra), a phosphodiesterase inhibitor – increases GMP levels.
It is effective and administrated orally, SE; headache (16%); flushing (10%);
nasal congestion (40%);
Predominantly blue/green tingeing of vision (due to inhibition of isoenzyme of PDE6 in the retina or increased pulsatile choroidal flow)
Contraindications to sildenafil (Viagra)
Concurrent use of nitrates
BP > 90/50 mmHG
Recent myocardial infraction
Degenerative retinal disorders
Active peptic ulceration
Risk of priapmism (sickle cell anaemia, myeloma , leukemia)
Concurrent complex antihypertensive régiments
Dyspnoea on minimal effort (sexual activity may be unsupportable)
There is a theoretical risk of interactions with inhibitors of cytochrome,
such as cimetidine.
Use in men with severe coronary disease has been a question, but in one careful study,
no adverse cardiovascular effects of were detected in men with severe coronary artery disease.