Introduction to Psychosexual Medicine Doctor Gillian Vanhegan Member of the Institute of Psychosexual Medicine

Session Four Male Problems Incidence of ED Physical causes Psychological causes Medical treatment Surgical treatment Psychodynamic therapy

Erectile Dysfunction Persistent inability to attain and or maintain an erection sufficient for sexual performance ED has a significant impact on the quality of life for patients and their partners

Massachusetts Male Ageing Study In men aged 40 to 70 years (1290 subjects in study) 52% had ED 10% seek or receive treatment

Organic causes Vascular Neurogenic Hormonal Penile injury or disease Medications

Underlying diseases 68% of men with hypertension have ED 60% of men with ED have dyslipidaemia 20% of men with ED have Diabetes 11% of men with ED have depression

Psychogenic causes Depression Performance anxiety Relationship problems Psychosocial problems Psychological distress

Differences between organic and psychogenic Masturbation Early morning erections Nocturnal erections Situational ED

The Erection Complex neurovascular phenomenon, which is under hormonal control Arterial dilation Trabecular smooth muscle relaxation Activation of corporeal venous occlusive mechanism

Physical treatments First Line = PDE5 inhibitors Sildenafil (Viagra) Tadenafil (Cialis) Vardenafil (Levitra) Followed by vacuum devices

PDE5 Inhibitors They inhibit the degradation of cyclic GMP to enhance smooth muscle relaxation, thus allowing increased blood flow to the penis Side –effects are flushing, headache and disturbance of colour vision Contraindication: Nitrates

Physical treatments Second Line = Intracavernosal injection, or intraurethral Alprostadil Third Line = Penile prosthesis or implant

Physical Treatment for PE SSRIs, Dapoxetine Local Anaesthetic in condoms, such as ‘Performa condoms’ Squeeze technique

Psychogenic causes Younger men, nervousness and performance anxiety. Cultural or religious influences. Possible sexual bullying or abuse. Older men, midlife relationship problems, redundancy and loss of self esteem, competition from younger men.

Next Session Female Problems Pain with sex Vulvodynia Vaginismus