Erectile dysfunction is the inability to get or maintain an erection firm enough for sex. It can be caused by physical or psychological factors such as vascular disease, diabetes, depression, or performance anxiety. Treatments include oral medications like Viagra, vacuum devices, injections, implants, or counseling. Premature ejaculation involves ejaculating sooner than desired during sex and can be treated with behavioral techniques or medications. Proper diagnosis involves taking a medical and sexual history to determine the underlying cause.

3. Erectile dysfunction..
Erectile dysfunction (ED) also called
impotence, is in inability to achieve or maintain
an erection sufficient to accomplish
intercourse.

4. What is Erectile dysfunction..?
•Erectile dysfunction, also known as ED, is a
condition in which a person is unable to get
or keep erection firm enough to have a sexual
intercourse.

5. Causes of erectile dysfunction :
•Psychogenic (psychological)
•Organic

6. Psychogenic (psychological)
E.g.1. Massive emotional stress.
2. Depression
3. Performance an anxiety during in sexual
activities.
4. Marital difficulties and Fatigue

7. Organic causes..
1. Vascular disorders
2. Arterial ( atherosclerosis, DM, radiation
therapy, tobacco and Hyperlipdemia)
3. Venous leak
4. Neurological (CVA)
Others including DM, alcohol abuse, Multiple
sclerosis and degenerative disorders of nervous
system (PDs).

8. Conti…
Parkinson‘s disease, spinal bifida, brain /spinal
cord trauma, pelvic fracture radiation therapy
and radical pelvic surgery e.g radical cystectomy
and radical prostatectomy)

10. Medications including..
Beta blockers
•Calcium channel blockers
•NSAIDs and thiazide diuretics.

11. Chronic medical disorders
For Examples. Kidney disease ( CRF) ,Liver
disease, Heart disease, and Chronic respiratory
disorders (emphysema, COPD)

14. Penile issues
Example. Peyronine‘s disease
Priapism
Penile trauma

15. Peyronine‘s disease

16. Peyronine‘s disease

17. Priapism

18. Other causes
•Hormonal (inadequate production of
(traumatic injury, penile disorders.
androgens, Hypo and hyperthyroidism.
• Anatomical dysfunction.

19. •The first step in diagnosis and management of
ED begins with a through collection of
1. Sexual history
2. Health and Medical history
3. Medications history and psychosocial history.
•Further examination or diagnostic testing is
typically based on findings the history and
physical examination.

20. Others diagnostic investigations
•A serum glucose and lipid profiles
recommend to rule out diabetes mellitus.
•And analysis of presenting symptoms and
physical examination include a neurologic
examination.

21. •A detailed assessment of medications,
alcohol and drugs used and various
laboratory studies.
•Doppler probe to assess arterial blood flow to
the penis.

22. The goal of ED is for the patient and his
partner to achieve a satisfactory sexual
relationship.
The treatment of ED based on the
underlying causes.
* Modifiy reversible causes

23. First line intervention for erectile dysfunction
•Sidenafil ( viagra), Vardenafi and tadalafi.
•Vacuum construction device ( VCD)

25. •First line interventions.
* Oral drug therapy : Sidenafil (viagra) tadalafi
(cialis) and Vardenafi (nuviva) are erctogenic
drugs, because of these drugs have been found
to be safe and effective for the treatment of
most types of ED.

26. •Conti..
These drugs cause smooth muscle relaxation
and increase arterial inflow with corporal
venooclusion resulting in erection. (they are
taken orally about 1hour before sexual activity,
but not more than once a day.

27. Vacuum construction device ( VCD)

28. Vacuum construction device ( VCD)

29. •A vacuum constriction device (VCD) is an
external pump that a man with erectile
dysfunction can use to get and maintain an
erection.

30. Side effects of VCD

32. •Sex therapy is a type of psychotherapy — a
general term for treating for mental health and
psychological problems that affecting sexual life's
of the individuals by talking with a mental health
professional.
•Through sex therapy, can address concerns about
sexual function, sexual feelings and intimacy,
either in individual therapy or in joint therapy with
your partner.

33. Second line interventions for erectile dysfunction
1. Intra urethral medication pellet
2. Intra cavernosal self- injection

36. Intra cavernosal self- injection

37. •CAVERJECT is indicated for the treatment of
erectile dysfunction due to neurogenic,
vasculogenic, psychogenic, or mixed etiology.
•

38. Home injection therapy instruction is given to
those men who are suitable candidates for the
therapy.
This injection is nearly painless and generally
begins to work in 20 to 30 minutes. Success
rates have been high when there is adequate
patients teaching and follow – up.

39. Conti..
This treatment is not suitable for men with
severe vascular problems, severe psychiatric
disease, poor vision or those receiving anti
coagulation therapy.

40. Penile pain 37%
Prolonged erection 4%
Penile fibrosis** 3%
Injection site hematoma 3%
Penis disorder*** 3%
Injection site ecchymosis 2%
Penile rash 1%
Penile edema

41. Third line interventions for erectile dysfunction
* Penile implants :
.

42. Penile implants

43. Risk of Penile implants
1. The site of the implant may become
infected.
2. The risk of infection is higher in men who
have diabetes, spinal cord injuries, or
urinary tract infections. If the infection is
severe, the implant must be removed.

44. Other treatments for erectile dysfunctions
•Treatment can be medical, surgical or both,
depending on the cause.
•Non – surgical therapy includes treating
associated conditions such as alcoholism and
readjustment of Anti hypertensive and other
drugs.

45. •Insufficient penile blood flow may be treated
with vascular surgery.
•Patients with ED from any psychological or
Psychogenic causes are referred to health
care provider or therapist.

46. Nursing management.
•The man experiencing ED requires a great
deal of emotional support for both himself
and his partner.
•The patient need reassurance that
confidentiality will be maintained.

49. •Premature ejaculation (PE) is a form of sexual
dysfunction that can adversely affect the quality
of a man's sex life.
•PE might occasionally complicate reproduction,
but it can also adversely affect sexual satisfaction,
both for men and their partners.

50. Pre mature ejaculation occurs when a man
cannot control the ejaculatory reflex and once
aroused, reaches orgasm before or shortly
after intromission.

51. Causes are including for premature
ejaculation
*Neurological disorder (spinal cord injury,
Multiple sclerosis, Neuropathy secondary to
diabetes mellitus, & Prostate diseases.)
• Surgery (prostatectomy) & medications are
the most common causes of inhibited
ejaculation.
• Psychological factors such as emotional
stress, depression, anxiety, guilty and issues
with body image.

52. • Hormonal imbalance
• Certain Medications and drugs

53. Types of Premature Ejaculation

54. •Lifelong premature ejaculation is a condition
that has been present in a male for his entire
life, and has been affecting him since his first
sexual experience.
•According to various research studies shown
91% of lifelong premature ejaculation cases
are caused by genetic factors.

55. • Acquired premature ejaculation is what the condition is
referred to when a male who has a normal sex life and
typically has a standard sexual performance suddenly
begins to ejaculate prematurely.
• Acquired premature ejaculation may be caused by stress or
anxiety related to a new relationship as well as seemingly
unrelated issues such as work or finances.
• In some cases it could even be a result of an imbalance of
serotonin.

56. •Subjective premature ejaculation is when a male
thinks he experiences premature ejaculation,
either consistently or inconsistently.
• Subjective premature ejaculation is characterized
by a male having a preoccupation with this
imagined premature ejaculation, or a
preoccupation with feeling as though he cannot
control the timing of his ejaculation.

57. •This is premature ejaculation that occurs
irregularly and inconsistently.
•In other words, while the male may typically
experience standard sexual performance, he may
begin to ejaculate prematurely in certain
instances.

58. Assessment and diagnosis
1. History collection ( Sexual history, Medial history,
Medications history, Psychological history)

59. Treatment
• Practice and relaxation should help you deal with the
problem. Some men try to distract themselves by
thinking nonsexual thoughts (such as naming baseball
players and records) to avoid getting excited too fast.
• There are several helpful techniques you can try. The
"stop and start" method:
• This technique involves sexually stimulating the man
until he feels like he is about to reach orgasm. Stop the
stimulation for about 30 seconds and then start it again.

60. Prevention
•There is no way to prevent this disorder.
However, relaxation can make it less likely to
occur.