5. *The superficial dorsal vein is separated
from the deep dorsal
bundle(vein,artery,nerve)by Buck’s fascia.
*The corpora cavernosa are traversed by
the deep penile arteries(cavernosal
arteries).
*The corpus spongiosum is traversed by the
penile urethra & urethral arteries.
18. Evaluation of Erectile Dysfunction
A.History
1.Personal:age,marital status,work,special habits,sleep pattern
2.Sexual:development,sex education,masturbation,phobias…….
3.History of ED:onset,course,duration
Desire,Arousal
Erection(morning,masturbation,situational)
Rigidity(easy intromission,manual help)
*Medical:coronary,vascular,hepatic,renal,neurologic,pelvic
trauma,op.,medication)
*History of partner:attitude & orientation
19. Evaluation of ED (cont.)
B.Examination
1.General:
-2ry sex characters -signs of systemic diseases
-breast enlargement -femoral & LL pulsation
-neurological examination in diabetes or neurogenic complaints
2.Genital:
Penis:size,cordee,pyeronie’s balanitis,urethritis,ulcers
Testis:size,consistency,sensation,varicocele
P/R:prostate,S.V,anal sphincter tone,smear
Genital & Perianal sensation & reflexes
20. Evaluation of ED (cont.)
C.Rigiscan
Measures circumfrential changes & rigidity during
sleep
D.Evaluation of penile arteries
Doppler,Duplex U/S,ICI
E.Evaluation of penile venous system
Cavernosometry,Cavernosography
26. Treatment of ED
*Medical
-Control of diabetes
-Avoid drug induced ED
-Yohimbine
-Androgen
-Bromocriptine
-Sildenafil Citrate (Viagra)
27.
28. Treatment of ED (cont.)
*ICI
-Papaverine
-Bimix:Papaverine/Phentolamine
-PGE1
-Trimix:Papaverine/Phentolamine/PGE1
-Quadmix:Papaverine/Phentolamine/PGE1/Atropine
29. Treatment of ED (cont.)
*Vacuum device
*Surgery
-Penile prosthesis
-Re-vascularization
30.
31.
32.
33. Premature Ejaculation
*Definition:
The inability of the male to control ejaculation long
enough to satisfy his partner in at least 50% of
their sexual encounters,when there is no female
orgasmic dysfunction.
*Etiology:
1.Mal-conditioning
2.Anxiety
3.Organic causes (rare)
34. Premature Ejaculation (cont.)
*Treatment:
1.Reassurance of the couple and explanation of
the problem to correct any sexual false ideas.
2.Drugs:e.g
Thioridazine(Meleril),Clomipramine(Anafranil)
and Selective Serotonin Reuptake
Inhibitors(SSRI).
3.Sex Therapy
4.Local anesthetics and condoms.
36. 1-Branches of pudendal artery in male include all
except:
a)Bulbar artery
b)Urethral artery
c)Cavernosal artery
d)Cremasteric artery
e)Dorsal artery of the penis
37. 2-PDE inhibitors induces erection through:
a)Release of nitric oxide
b)Inhibition of conversion of GTP to cGMP
c)Inhibition of conversion of cGMP to GTP
d)Inhibition of alpha1 adrenergic receptors