Erectile dysfunction      Michael Lefever
Why erectile dysfunction• This topic is often laughed at, but can be symptom  of current/future problems• This topic is of...
What is erectile dysfunction     • According to Stacy Elliot, MD, erectile dysfunction is       defined as “the persistent...
What is an erection and what causes erectile                   dysfunction?     • When a male is sexually stimulated/arous...
Pathway to an erection     • an erection is dependent on the nitric oxide-cyclic       guanosine monophosphate pathway    ...
Cardiovascular disease       • Cardiovascular disease can affect the ability to         maintain an erection       • Erect...
Cardiovascular (cont.)• Cohort study on patients with erectile dysfunction• 13 item structured interview of 1,697 patients...
Cardiovascular (cont.)• That erectile dysfunction shows early coronary  artery disease due to smaller arteries when  compa...
Diabetes and Erectile dysfunction      • Erectile dysfunction is a common side effect of        diabetes and 36% of men wi...
Other causes of erectile dysfunction        • Erectile dysfunction can be linked to metabolic          disease and lowered...
Other causes of erectile dysfunction• Obesity also leads to increased insulin, glucose, C-  peptide levels, and reduced pl...
Psychology and Erectile Dysfunction    • Sexual dysfunction can lead to:         •    incompetence schema         •   erec...
So in other words My erection is a        I’m older,                         not deadgood indicator of   my health!
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April 25 presentations

  1. 1. Erectile dysfunction Michael Lefever
  2. 2. Why erectile dysfunction• This topic is often laughed at, but can be symptom of current/future problems• This topic is often uncomfortable for both the practioner and the patient due to stigma• This topic is often ignored by students
  3. 3. What is erectile dysfunction • According to Stacy Elliot, MD, erectile dysfunction is defined as “the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance” • Sexual performance: • Intercourse • Masturbation • Same gender sexual activity • or other stimulatory methodsElliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
  4. 4. What is an erection and what causes erectile dysfunction? • When a male is sexually stimulated/aroused, blood will engorge the penis allowing sexual activities to commence. • Erectile difficulties are often the result of inadequate blood inflow due to: • cardiovascular disease • obesity related, smoking, hypercholesterolemia • Diabetes • metabolic syndrome • disrupted neurological signals • SSRIs used to treat depression • venous leaksElliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
  5. 5. Pathway to an erection • an erection is dependent on the nitric oxide-cyclic guanosine monophosphate pathway • at penile nerve endings and healthy endothelial lining • these areas can be damaged by hypertension, hyperlipidemia, and smoking http://www.nature.com/ijir/journal/v20/n4/fig_tab/ijir20084f1.htmlElliott, S. L. (2011). Hot topics in erectile dysfunction. BC MedicalJournal, 480-486.
  6. 6. Cardiovascular disease • Cardiovascular disease can affect the ability to maintain an erection • Erectile dysfunction can be used as a marker for physicians to discuss cardiovascular disease and prevent fatal heart attacks • Potentially the most efficient predictor of silent coronary artery disease in diabetic population** ** Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi,Elliott, S. L. (2011). Hot topics in erectile M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectiledysfunction. BC Medical Journal, 480-486. Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
  7. 7. Cardiovascular (cont.)• Cohort study on patients with erectile dysfunction• 13 item structured interview of 1,697 patients followed for an average of 4 years• 159 patients suffered a major cardiovascular event • 15 were fatal • 85 were ischemic heart disease • 41 of these were acute myocardial infarction • 40 cerebral (stroke or transient ischemic attack) • 14 peripheral artery disease Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
  8. 8. Cardiovascular (cont.)• That erectile dysfunction shows early coronary artery disease due to smaller arteries when compared to coronary arteries.• Individuals with severe erectile dysfunction has an 80% increased risk for cardiovascular disease• Erectile dysfunction can be used as indicator of future cardiovascular disease Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
  9. 9. Diabetes and Erectile dysfunction • Erectile dysfunction is a common side effect of diabetes and 36% of men with diabetes will experience some for of erectile dysfunction • Erectile function is dependent on the patients age, need for insulin, glucose control, and how long the patient has been diagnosed with diabetes • Men who are diabetic should be routinely asked about erectile dysfunction and that blood glucose monitoring is not enough to determine if a patient is likely to experience erectile dysfunctionTyagi, S., & Roy, R. K. (2010). Effective therapy for the managment of erectiledysfunction in men with diabetes mellitus: a review. International Journal of Pharma and Bio Sciences, 1(2), 1-12.
  10. 10. Other causes of erectile dysfunction • Erectile dysfunction can be linked to metabolic disease and lowered testosterone • Caused by the natural decline in testosterone in the aging male, which in turn, also plays a part in the build up of central fat deposits leading to metabolic syndrome • Visceral adipose tissue is an endocrine organ and is directly related to cardiac risk.** **Traish, A. M., Feeley, R., & Guay, A. (2009). Mechanisms of obesity and related pathologies: Androgen deficiency andYassin, A. A., Akhras, F., El-Sakka, A. I., & Saad, F. (2010). Cardiovascular diseases endothelial dysfunction may be the link betweenand erectile dysfunction: the two faces of the coin of androgen deficiency. Andrologia, 1-8. obesity and erectile dysfunction. FEBS Journal, (276), 5755-5767.
  11. 11. Other causes of erectile dysfunction• Obesity also leads to increased insulin, glucose, C- peptide levels, and reduced plasma testosterone• Erectile dysfunction is much more common in men with a BMI greater than or equal to 25 (59.3% in a study of 158 men) **Traish, A. M., Feeley, R., & Guay, A. (2009). Mechanisms of obesity and related pathologies: Androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction. FEBS Journal, (276), 5755-5767.
  12. 12. Psychology and Erectile Dysfunction • Sexual dysfunction can lead to: • incompetence schema • erection concern thoughts • lack of erotic thoughts • sadness • continued erectile dysfunction all due to the fact that many men believe they must have continual successful sexual performance that pleases sex partners 100% of the timeNobre, P. (2010). Psychological determinants of erectile dysfunction: testing a cognitive-emotional model.International Society for Sexual Medicine, (7), 1429-1437.
  13. 13. So in other words My erection is a I’m older, not deadgood indicator of my health!

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