Impotence

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Introduction 3 Etiology 4 Epidemiology 5 Laboratory 6 Radiology 7 Management 8 More General Terms 9 References

More Specific Terms

• erectile dysfunction (ED)
• impotence in diabetics

Introduction

• Sexual dysfunction in a male.

Etiology

• endocrine

• testicular failure

• primary
• secondary

• hyperprolactinemia
• diabetes mellitus

• pharmacologic agents [4]

• androgen antagonists

• histamine H2 receptor antagonists

• cimetidine

• spironolactone
• ketoconazole
• finasteride

• estrogen
• antihypertensive agents

• centrally acting sympatholytics

• clonidine
• methyldopa

• peripherally acting sympatholytics

• guanadrel
• guanethidine

• beta-adrenergic receptor antagonists ( beta blockers)
• thiazide diuretics

• digoxin
• anticholinergic agents
• antidepressants

• monoamine oxidase ( MAO) inhibitors
• tricyclic antidepressants ( TCA)
• selective serotonin receptor antagonists
• selective norepinephrine reuptake inhibitors

• duloxetine, venlafaxine

• antipsychotic agents

• lithium carbonate
• haloperidol
• thorazine

• central nervous system depressants

• sedatives: barbiturates
• antianxiety agents: benzodiazepines

• drugs of habituation or addiction

• alcohol
• opiates
• tobacco
• marijuana
• cocaine [2]

• anticonvulsants

• phenytoin, carbamazepine, primidone

• corticosteroids
• statins ? [3]

• penile diseases

• Peyronie's disease
• previous priapism
• penile trauma

• neurologic diseases

• anterior temporal lobe lesions
• diseases of the spinal cord
• loss of sensory input

• tabes dorsalis
• disease of dorsal root ganglia

• trauma to the pelvic splanchnic nerves ( nervi erigentes)

• radical prostatectomy & cystectomy
• rectosigmoid operations

• diabetic autonomic neuropathy
• polyneuropathy

• vascular diseases

• aortic occlusion ( Leriche syndrome)
• atherosclerotic occlusion or stenosis of the pudendal &/or carvernosa arteries
• arterial damage from pelvic radiation
• venous leak
• disease of the sinusoidal spaces

• psychogenic impotence

• anger
• depression

Epidemiology

• 5% of men at 40 years of age
• 15% of men at 70 years of age

Laboratory

• serum chemistries

• serum glucose
• serum testosterone, free testosterone

• serum FSH & serum LH if serum testosterone is low

• serum prolactin
• serum luteinizing hormone
• serum urea nitrogen
• serum creatinine

• hemoglobin A1c

Radiology

• pudendal arteriography
• pulsed doppler analysis combined with intracorporeal injection of alprostadil

Management

• general

• also see erectile dysfunction
• androgens

• of little or no benefit [1]
• testosterone replacement if testosterone is low [2]

• intramuscular or transdermal

• yohimbine widely prescribed, but works only as placebo in psychogenic impotence
• injection of prostaglandin E2 ( alprostadil)
• commercially available mechanical devices

• vacuum to produce an erection
• rubber band to constrict venous return at the base of the penis

• penile prosthesis - highest rate of complications

• treatment of specific etiology

• prolactinoma

• surgical removal
• bromocryptine

• surgical correction of arterial disease
• control of diabetes

• psychotherapy for dysfunctional relationships, anger, depression

More General Terms

• sexual dysfunction
• sign/symptom

References

1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 286
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
3. Rizvi, K et al, Do lipid-lowering drugs cause erectile dysfunction? A systematic review Family Practice 2002, 19:95 PMID: [1]
   - Pedersen TR & Faergeman O Simvastatin seems unlikely to cause impotence. BMJ 1999, 16:318 PMID: [2]
   - Halkin A et al, HMG-CoA reductase inhibitor-induced impotence. Ann Pharmacother 1996, 30:192 PMID: [3]
4. Prescriber's Letter 13(9): 2006 Drugs That May Cause Male Sexual Dysfunction Detail-Document#: [4] (subscription needed) [5]
5. NIH Institute and Center Resources [6]
6. National Guideline Clearinghouse Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Association of Urology ngc-guideline: [7]

impotence