Disorder of male sexual function

1. DISORDER OF MALE SEXUAL
FUNCTION… .

2. Disorder of male sexual function mainly
 Erectile dysfunction
 Disorders of ejaculation

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

4. Causes of erectile dysfunction :
Psychogenic (psychological)
Organic

5. Psychogenic (psychological)
.E.g stress
Depression
Performance an anxiety
Marital difficulties and
Fatigue

6.  Organic causes..
Vascular
1. Arterial ( atherosclerosis, DM, radiation therapy,
tobacco and Hyperlipdemia)
2. Venous leak
3. Neurological (CVA)
Others including DM, alcohol abuse, Multiple sclerosis

7. 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)

8. Medications including..
Antiadrenergics
Anti hypertensive
Anti cholinergics
Anti seizure agents Anti hormone
Anti psychotic

9. Beta blockers
Calcium channel blokers
NSAIDs and thiazide diuretics.

10. Chronic medical disorders.
Examples. Kidney disease
Liver disease
Heart disease
Emphysema

12. Penile issues
Example. Peyronine‘s disease
Priapism
Penile trauma

13. Hormonal (inadequate production
of androgens, Hypo and
hyperthyroidism.
 Anatomical (traumatic injury,
penile disorders.

14. Assessment and diagnostic findings..
• The first step in diagnosis and management
of ED begins with a through sexual, health
and psychosocial history.
• Further examination or diagnostic testing is
typically based on findings the history and
physical examination.

15. A serum glucose and lipid profiles
recommend to rule out diabetes
mellitus.
And analysis of presenting symptoms
and physical examination include a
neurologic examination.

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

17. Medical management.
The goal of ED is for the patient and
partner to achieve a satisfactory sexual
relationship. The treatment of ED
on the underlying causes.
* Modifiy reversible causes

18. First line intervention.
• Sidenafil ( viagra), Vardenafi and
tadalafi.
• Vacuum construction device ( VCD)

20. Conti…
Sexual therapy.

21. Second line interventions.
• Intra urethral medication pellet
• Intra cavernosal self- injection

23. Third line interventions.
* Penile implants

26. 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.

27. 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.

28. 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.

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

30. Vacuum constriction device. (VCD).
A second option that is considered
a first line intervention is the
vacuum constriction device.

31. Suction device applied to the flaccid
penis produce an erection by pulling
blood up into the corporeal bodies.
Special care must be taken in using
these devices to prevent tissue
bruising.

32. Sexual therapy.
Treatment of ED may include sexual
therapy.
This therapy address psychologic or
interpersonal factors that may enhance
sexual expression, as well as other factors
that of concern.

33. Second line interventions : The
second line interventions or
therapies are indicated for patients
for whom firs line interventions fail.
Or based on the patient
preference.

34. This interventions include the use of
vasoactive drugs, administered as
topical gel, an injection into the penis
(Intra cavernosal self – injection) or
insertion of a medication pellet into
the urethra, (Intra urethral).

35. Vasoactive drugs enhance blood flow into the
penile arteries, current vasoactive medications
include “papaverine” (topical gel or injection.
Vasoactive medications dose is regulated on an
individual basis to prevent side effects (side effects
may include penile pain, priapism, corporal fibrosis
and hypotension)

36. Conti..
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.

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

38. Third line interventions.
Third line interventions include surgical
implantation of semirigid or inflatable penile
prostheses are third line interventions
associated with many complications. Thus they
are usually indicated for men with severe ED in
which first and second line interventions are
failed or ineffective.

39. 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.

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

41. Causes are including for premature
ejaculation
*Neurological disorder (spinal cord injury,
Multiple sclerosis, Neuropathy secondary to
diabetes mellitus.)
* Surgery (prostatectomy) & medications are
the most common causes of inhibited
ejaculation. AA

42.  Treatment modalities depend on the
nature and severity of the ejaculation
problem.
 Behavioral therapies may be indicated for
treatment of Premature ejaculation, these
therapies involves both the man and his
sexual partner.