This document discusses erectile dysfunction (ED), including its causes, evaluation, and treatment. Physiologic changes with aging can include declining testosterone and longer refractory periods between erections. ED is defined as the inability to attain or maintain an erection for satisfactory sex. Common causes of ED include vascular diseases, neurological disorders, medications, psychological factors, and endocrine abnormalities. Evaluation involves history, exam, and tests. Treatment options include lifestyle changes, counseling, oral medications like PDE5 inhibitors, penile injections or implants, vacuum devices, and testosterone therapy for hypogonadism.
Dr. Aaron Spitz's 2006 presentation on disorders of ejaculation. Presented as part of his work as an Assistant Clinical Professor at UC Irvine's Department of Urology.
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
Dr. Aaron Spitz's 2006 presentation on disorders of ejaculation. Presented as part of his work as an Assistant Clinical Professor at UC Irvine's Department of Urology.
Erectile Dysfunction: New Paradigms in Treatment Ranjith Ramasamy
1. Discuss diagnosis of erectile dysfunction
2. Treatments of ED using Viagra, Cialis, Trimix (intracavernosal injections)
3. Evaluate penile prosthesis and implant as ED surgical therapy options
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
Hyperparathyroidism is medical condition where overactivity of one or more of the body's four parathyroid glands leads to excess of parathyroid hormone in the bloodstream.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Invited Lecture by Dr Sujoy Dasgupta in a webinar- COGNIZANCE 2021, by Perinthalmanna Ob-Gyn Society, Kerala Federation of Obgyn and FOGSI, held in June, 2021
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
Hyperparathyroidism is medical condition where overactivity of one or more of the body's four parathyroid glands leads to excess of parathyroid hormone in the bloodstream.
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss of bladder control.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Invited Lecture by Dr Sujoy Dasgupta in a webinar- COGNIZANCE 2021, by Perinthalmanna Ob-Gyn Society, Kerala Federation of Obgyn and FOGSI, held in June, 2021
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
LECTURE ON RELATIONSHIP BETWEEN OBESITY, TESTOSTERONE DEFICIENCY AND ERECTILE DYSFUNCTION
BY
PROF. DR. SEMIR AL SAMARRAI
DUBAI HEALTHCARE CITY
URO-SURGEON, ANDROLOGIST
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Mohand Yaghi
A lecture about the effect of diabetes mellitus on the erectile function. Dr. Mohand Yaghi was an invited speaker in Al-Jahra scientific day, Kuwait 2015.
Erectile Dysfunction Symptoms And TreatmentManas Das
This presentation describes Symptoms And Treatment of Erectile Dysfunction which is a very common diseases in men.Erectile Dysfunction can be cure easily if proper treatment will be taken.To identify Erectile Dysfunction some symptoms are there which can help you.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
Disorder of male sexual function mainly Erectile dysfunction
Disorders of ejaculation .Erectile dysfunction (ED) also called impotence, is in inability to achieve or maintain an erection sufficient to accomplish intercourse. causes are Psychogenic (psychological) or Organic.Pre mature ejaculation occurs when a man cannot control the ejaculatory reflex and once aroused, reaches orgasm before or shortly after intro mission.
Andrology (an-drol’-uh-jee): The study of the functions and diseases specific to males, especially of the reproductive organs.
It is an equivalent to Gynaecology for women meaning gynaecologists deal with female reproductive health problems
Despite common origins of both Andrology and Gynaecology from Greek language, the branch of Andrology has not become a mainstream medical branch as opposed to Gynaecology.
Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. It is defined as the persistent inability to achieve penile erection sufficient for satisfactory sexual performance.
Erectile Dysfuncation and Scleroderma is presented by
N. Bennett, MD, FACS
Associate Professor of Urology, Department of Urology, Northwestern University, Feinberg School of Medicine
Co-Director Andrology Fellowship
social cognition domains and impairment.pptxDoha Rasheedy
Social cognition refers to a set of neurocognitive processes underlying the individuals’ ability to “make sense of others’ behavior” as a “crucial prerequisite of social interaction” The different psychological processes by which we perceive, interpret, and process social information about ourselves and others. These processes allow people to understand social behavior and respond in ways that are appropriate and beneficial Social cognitive impairments are a prominent concern, or even a core facet, of several neurodegenerative (e.g., behavioral variant of frontotemporal dementia), neuropsychiatric (e.g., schizophrenia, major depressive disorder, and bipolar disorder), and neurodevelopmental (e.g., autism spectrum disorder and attention deficit hyperactivity disorder) conditions, and often occur after acute brain damage (e.g., traumatic brain injury and stroke). Moreover, such deficits are critical predictors of functional outcomes because they affect the ability to create and maintain interpersonal relationships, thereby removing their benefits in everyday life Social cognitive disturbances might be relatively subtle and harder to detect informally. Structured social cognitive assessment is, therefore , mandated.
Basic of geriatrics and internal medicine for physiotherapistDoha Rasheedy
collection of lectures for physiotherapy undergraduate students including notes of common health issues (frailty, sarcopenia, osteoporosis, neuropsychiatric issues, constipation, metabolic syndrome and its components, orthostatic hypotension, CLD, CKD, anemia, immobilization, dizziness, falls, fatigue) and how to handle in practice.
summary of age related changes and geriatric pharmacology, safe analgesic prescription in elderly
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Impotence
1. Erectile Dysfunction
Dr. DOHA RASHEEDY ALY
Lecturer of Geriatric Medicine
Department of Geriatric and Gerontology
Ain Shams University
2.
3. Physiologic changes in sexual
function with aging in men
• Testosterone levels gradually decline.
• More time is required for penile stimulation to
obtain and maintain a sufficient erection
• Prolongation of the plateau phase
• Orgasm becomes weaker with shorter intervals
• Reduction of semen volume.
• In the resolution stage, penile detumescence
occurs rapidly.
• Prolongation in the refractory period in the
interval between erections.
4. • ED is the persistent inability to attain or maintain a penile
erection sufficient for satisfactory sexual performance.
• There is no consensus on how often, or for what length
of time, the problem has to occur to meet this definition.
A duration of greater than 3 months or more than 25% of
attempts has been suggested as a reasonable clinical
guideline.
5. Physiology of Erection
• The male sexual cycle can be considered to have 4 phases:
sexual desire (libido), arousal (erection), ejaculation
(orgasm), and detumescence (penile flaccidity).
• Psychogenic and reflexogenic mechanisms play a role in this
chain of events.
• Psychogenic erections are triggered centrally in response to
visual, auditory, olfactory, or imaginary stimuli.
Reflexogenic erections are brought on peripherally by
stimulation of sensory receptors on the penis, involving
somatic and parasympathetic efferent actions via spinal
pathways.
6. • On a biochemical level, the parasympathetic activity
sets off the release of nitric oxide (NO), eventually
resulting in increased levels of the intracellular
mediator cyclic guanosine monophosphate (cGMP),
which in turn causes penile vascular and trabecular
smooth muscle relaxation.
• In the flaccid state, the penis maintains a balance
between the blood flowing into the corpora cavernosa
and the corpus spongiosum and the blood flowing out
via postcavernous venules that eventually drain into
the deep dorsal vein.
• During an erection, the blood flowing into the erectile
tissue increases considerably, compressing the venules
and restricting venous outflow, and eventually resulting
in full penile rigidity.
7. Pathophysiology of Erectile
Dysfunction
• The cause of erectile dysfunction is primarily
organic; however, psychogenic causes cannot be
ruled out as part of a differential diagnosis.
• vascular diseases.
• Neurologic diseases.
• Psychological disorders.
• Endocrine disorders.
• Structural abnormalities.
• Drugs.
8. vascular diseases
• vascular disease is the commonest cause of erectile dysfunction.
• There are two primary mechanisms by which vascular disease causes
erectile dysfunction: arterial insufficiency and venous leakage.
• Atherosclerotic arterial occlusive disease decreases perfusion
pressure and arterial flow to the lacunar spaces necessary to achieve
a rigid erection. ED may be the initial sign of serious vascular
disease, preceding MI or stroke.
• Ischemia also results in replacement of smooth muscle by connective
tissue, which results in impaired cavernosal expandability.
• Venous leakage, excessive outflow through the subtunical
venules, prevents the development of high pressure within the
corpora cavernosa necessary for a rigid erection. It is caused by an
increased number of venous outflow channels, decreased compliance
of trabeculae with inability to compress the subtunical venules, and
insufficient relaxation of trabecular smooth muscle.
9. Neurologic Disease
• Neurologic disease accounts for the second most
common cause of ED in older men.
• It results from disorders of the parasympathetic
sacral spinal cord or peripheral efferent
autonomic fibers to the penis, which impair penile
smooth muscle relaxation and prevent the
vasodilation needed for erection.
• Common neurologic causes of ED in older men
include autonomic dysfunction from diabetes
mellitus, stroke, or Parkinson’s disease, and injury
to autonomic nerves from radical prostatectomy
or proctocolectomy.
10. Medications
• antihypertensives, antidepressants, antipsychotics,
and anticholinergic medications, may predispose
an individual to erectile dysfunction.
• Abusive drugs, such as alcohol, heroin, cocaine,
and tobacco,have been associated with male
sexual dysfunction
11.
12. Psychosocial disorders
• psychogenic causes should not be neglected if testing for
organic causes is not fruitful.
• In addition to physical changes, psychosocial changes affect the
sexual lives of older persons. The loss of a sex partner through
divorce, mental or physical illness, or death can affect sexual
functioning.
• Role changes imposed by retirement or job loss can lead to
boredom, low self-esteem, and lack of confidence.
• Specific types of psychogenic erectile dysfunction include
performance anxiety and fear of sexually transmitted diseases.
Widower’s syndrome is a defense mechanism whereby the
widower develops erectile dysfunction secondary to guilt
feelings relating to his dead spouse, which prevents erection.
• Depression is frequently correlated with decreases in sexual
desire or function, while some antidepressants can increase
sexual dysfunction.
13. Endocrine disorders
• Hypogonadism
• Hyperprolactinemia decreases serum testosterone
concentration due to inhibition of gonadotropin-
releasing hormone secretion.
• Hypothyroidism may also cause ED via elevated
prolactin and low testosterone levels.
• Hyperthyroidism is more associated with a decline in
libido than with ED.
• Chronic alcoholism can cause ED via toxicity at the
hypothalamic-pituitary-gonadal levels, or peripheral
and autonomic neuropathy.
• Severe chronic obstructive lung disease with hypoxia
suppresses the hypothalamic-pituitary-gonadal axis
19. • A variety of additional testing modalities to
assess erectile function are available (e.g.,
nocturnal penile tumescence, intracavernous
injection, penile brachial blood pressure index
measurements, duplex ultrasonography,
penile cavernosography).
20. Treatment
• Therapy for ED includes risk factor modification, followed by
counseling and, when necessary, medication. Lifestyle
interventions such as healthy eating, weight loss, smoking
cessation, moderation of alcohol intake, and increased physical
activity have been shown to benefit men with ED by reducing the
markers of inflammation and improving endothelial function.
• Regardless of the primary cause of ED, there is often a coexisting
psychological element. Education, support, and reassurance may
be all that is needed to restore sexual function.
21. • Therapeutic options for ED include (1) external
vacuum tumescence devices, (2) oral
pharmacotherapy, (3) intracorporeal or
intraurethral pharmacotherapy, (4) penile
prostheses, or (5) for hypogonadal
men, testosterone.
22. Constriction rings
• which are made of rubber, slow venous
outflow at the base of the penis and may be
useful for men who can obtain erections but
cannot sustain them.
• Constriction rings can produce local
discomfort and, if too tight, difficulty with
ejaculation.
23. VACUUM THERAPY
• This involves placing a cylinder over an
unerect penis, sucking out air to produce an
erection, and applying a wide rubber band at
the base to maintain the erection. One third
of individuals who try vacuum devices find
them helpful. They should not be used by men
taking anticoagulants or those who have low
platelet counts.
24. oral pharmacotherapy
• PDE5 inhibitors: increases cGMP in the smooth muscle of the corpus
cavernosum, causing prolonged vasodilation and a firmer, longer-lasting
erection.
• PDE5 inhibitors have been shown to be effective in men with diabetes,
hypertension, coronary artery disease, peripheral vascular disease, and spinal
cord injury, as well as after coronary artery bypass surgery, transurethral
prostatectomy (TURP), and radical prostatectomy.
• The poorer the blood supply, the more damaged the nerves (such as from
surgery), and the more prolonged the dysfunction, the poorer the response.
• Unlike injection therapy, PDE5 inhibitors require sexual stimulation for an
erection to occur.
25. • concomitant use of nitrates is an absolute contraindication PDE5
inhibition potentiates the hypotensive effects of nitrates.
• The use of alpha adrenergic blockers also increases the risk for
hypotension and generally should be avoided.
• Relative contraindications include MI, stroke, or dysrhythmia
within the past 6 months; poorly controlled hypertension or
hypotension; uncompensated cardiac failure; unstable angina; a
predisposition to priapism; and retinitis pigmentosa.
• The most common side effects reported include headache,
flushing, dyspepsia, and nasal congestion. The inhibition of
phosphodiesterase 6 in the retina by sildenafil may cause altered
color vision–usually a blue tinge—or increased sensitivity to light
in some men.
26. • Yohimbine is an oral alpha-2 adrenergic-receptor
blocker that may improve erectile function better
than placebo, particularly in psychogenic
impotence.
• Studies remain ongoing for the use of
phentolamine, apomorphine, dopaminergic, and
many other agents.
27. INTRACORPOREAL OR INTRAURETHRAL
PHARMACOTHERAPY
• injection into the corpora cavernosa of
prostaglandin E1, papaverine, phentolamine, or
some combination of the three.
• Complications: prolonged erection (priapism) or
penile fibrosis,brusing.
• Prostaglandin E1 (alprostadil) can also be
administered intraurethrally as a small pellet. This
method relies on absorption from the
submucosal veins of the urethra that
communicate between the corpus spongiosum
and the corpora cavernosa.
28. IMPLANT
• A permanent penile prosthesis may help a patient
with an otherwise untreatable potency problem.
Such a prosthesis is irreversible and therefore should
be used only as a last resort.
• Penile implants can be noninflatable (positionable or
semirigid rod prosthesis) and inflatable.
• Contraindications to this treatment include
psychiatric problems such as psychosis and
untreated depression.
• Complications include infection, mechanical failure,
and penile fibrosis.
30. Penile revascularization surgery
• (especially arterial) is relatively experimental
and has not been found to have high success
rates.
• With venous disease, ligation surgery may
afford benefit in the short run.
31. Herbal remedies and alternative
medicine
• Although many herbal therapies are used for ED,
their efficacy and safety have yet to be properly
validated, and they are not clinically approved.
• Korean red ginseng, Korean black raspberry.
• acupuncture is an alternative treatment of ED,
but found insufficient evidence to suggest it as an
effective intervention and recommended further
research on its potential benefits.