Male Sexual Function (eBook)

Preface 6
Contents 7
Contributors 9
Normal Anatomy and Physiology 11
INTRODUCTION 11
FUNCTIONAL VASCULAR AND MICROSCOPIC ANATOMY OF PENILE ERECTION 12
FUNCTIONAL NEUROANATOMY OF PENILE FUNCTION 17
PENILE ERECTION AND FLACCIDITY: PHYSIOLOGICAL MECHANISMS 21
PENILE ERECTION AND FLACCIDITY: MOLECULAR MECHANISM OF CORPORAL SMOOTH MUSCLE RELAXATION AND CONTRACTION 25
SMOOTH MUSCLE CONTRACTION AND RELAXATION IS REGULATED BY Ca2+- INDUCED MYOSIN PHOSPHORYLATION AND DEPHOSPHORYLATION 25
MODES OF PENILE ERECTION 34
CENTRAL MECHANISMS OF PENILE ERECTION AND FLACCIDITY 36
SPINAL MECHANISMS AND PATHWAYS 39
PENILE ERECTION AND FLACCIDITY: CENTRAL NEUROPHYSIOLOGY 39
REFERENCES 44
Epidemiology of Erectile Dysfunction 56
INTRODUCTION 56
PREVALENCE AND INCIDENCE OF ERECTILE DYSFUNCTION 56
AGING AND ERECTILE DYSFUNCTION 59
RISK FACTORS FOR ERECTILE DYSFUNCTION 60
IMPACT OF ERECTILE DYSFUNCTION 62
TREATMENT-SEEKING BEHAVIOR 64
CONCLUSION 65
REFERENCES 65
Cardiac Issues Related to Erectile Dysfunction 69
INTRODUCTION 69
IS THE PATIENT PRESENTING WITH ED A CARDIAC PATIENT? 71
WHAT IS THE ADEQUATE RECOMMENDATION FOR PATIENTS WITH CARDIOVASCULAR DISEASE SEEKING TREATMENT FOR ED? 74
CONCLUSION 80
REFERENCES 80
How a Primary Care Clinician Approaches Erectile Dysfunction 84
INTRODUCTION 84
NATURE OF PRIMARY CARE 85
TRENDS IN PRIMARY CARE INVOLVEMENT IN SEXUAL HEALTH 86
LEARNING TO COMMUNICATE WITH PATIENTS ABOUT SEXUAL ACTIVITY 87
NOT ALL MEN ARE HETEROSEXUAL 88
SCREENING FOR ED 89
PATIENTS AND PARTNERS INITIATE DISCUSSIONS ABOUT SEXUAL PROBLEMS 91
POTENTIAL VALUE OF ED INQUIRY AND MANAGEMENT ( TABLE 9) 92
BARRIERS PREVENTING MEN FROM DISCUSSING ED 94
THE NEXT STEP AFTER IDENTIFYING ED 95
CHARACTERISTICS OF A SEXUAL PROBLEM 96
EVALUATING THE MAN WITH ED 96
TREATMENT OF ED 101
ISSUES AMONG OLDER MEN 104
FOLLOW-UP OF TREATMENT FOR ED 105
CONSULTATION 105
MANAGING SEXUAL HEALTH PROBLEMS CAN ENHANCE A PRACTICE 106
REFERENCES 108
Psychosocial Aspects Related to Erectile Dysfunction 112
INTRODUCTION 112
A MULTIDIMENSIONAL COMBINATION TREATMENT APPROACH 113
THE SEXUAL TIPPING POINT MODEL 114
DEFINITION 115
ETIOLOGY 115
ASSESSMENT 117
SEXUAL STATUS EXAMINATION 119
EXPLORING OTHER PSYCHOSOCIAL ISSUES 120
PREVIOUS TREATMENT APPROACHES 121
PSYCHIATRIC CONSIDERATIONS 121
FAMILY AND EARLY PSYCHOSEXUAL HISTORY 122
PARTNER–RELATIONSHIP ISSUES 122
THE SINGLE PATIENT 122
QUESTIONNAIRES 122
TREATMENT 123
FOLLOW-UP AND THERAPEUTIC PROBE 124
WEANING AND RELAPSE PREVENTION 124
COMBINATION THERAPY MATRIX 125
REFERRAL 126
CONCLUSION 127
REFERENCES 127
Hormonal Evaluation and Treatment 130
INTRODUCTION 130
EFFECTS OF TESTOSTERONE ON SEXUAL FUNCTION 131
CLINICAL PICTURE OF HYPOGONADISM 131
OTHER HORMONES 133
LABORATORY DETERMINATION OF HYPOGONADISM 133
TREATMENT OF HYPOGONADISM 134
CAUTIONS IN TESTOSTERONE SUPPLEMENTATION 136
TESTOSTERONE FOR ERECTILE DYSFUNCTION 137
CONCLUSIONS 137
POSITION STATEMENT: UNITED STATES 138
REFERENCES 138
Radical Prostatectomy and Other Pelvic Surgeries 141
INTRODUCTION 141
EPIDEMIOLOGY 142
PATHOPHYSIOLOGY 143
FACTORS ASSOCIATED WITH RECOVERY OF ERECTILE FUNCTION FOLLOWING RADICAL PROSTATECTOMY 145
TREATMENT OF ED AFTER RADICAL PROSTATECTOMY 148
ED AFTER PELVIC SURGERY 150
BASIC SCIENCE AND FUTURE PERSPECTIVES 154
CONCLUSION 155
REFERENCES 155
Drugs That Affect Male Sexual Function 161
INTRODUCTION 161
PATHOPHYSIOLOGY 162
ANTIHYPERTENSIVES 164
ANTIDEPRESSANTS 171
ANTIPSYCHOTICS 176
BENZODIAZEPINES 178
H2- BLOCKERS 178
DIGOXIN 179
ANTILIPEMICS 180
ANTICONVULSANTS 180
HORMONAL AGENTS 182
RECREATIONAL DRUGS 183
CONCLUSION 187
REFERENCES 187
Neurogenic Sexual Dysfunction in Men and Women 200
INTRODUCTION 200
NEUROANATOMY OF THE PENIS 201
NEUROANATOMY OF THE FEMALE GENITALS 202
NEUROPHYSIOLOGY OF SEXUAL RESPONSE IN MEN 203
NEUROPHYSIOLOGY OF SEXUAL RESPONSE IN WOMEN 208
NEUROLOGICAL CAUSES OF SEXUAL DYSFUNCTION 211
REFERENCES 222
Female Sexual Dysfunction 232
INTRODUCTION 232
SEXUAL HEALTH CARE DELIVERY TO WOMEN WILL INCREASE IN THE FUTURE 233
EPIDEMIOLOGY AND CLASSIFICATION 234
PHYSIOLOGY AND PATHOPHYSIOLOGY: EFFECT OF THE MALE PARTNER WHO HAS ERECTILE DYSFUNCTION 236
WOMEN WITH MEN WHO SUFFER FROM PREMATURE EJACULATION 237
PHYSIOLOGY AND PATHOPHYSIOLOGY: CHANGES IN THE FEMALE GENITALIA WITH AGING 238
PHYSIOLOGY AND PATHOPHYSIOLOGY: EFFECTS OF SEX STEROID HORMONES ON THE VAGINA 239
DIAGNOSIS OF WOMEN WITH SEXUAL HEALTH CONCERNS 240
TREATMENT 245
SEXUAL PAIN MANAGEMENT 248
SURGICAL THERAPY FOR GENITAL SEXUAL PAIN DISORDERS 251
OTHER SURGICAL PROCEDURES 252
CONCLUSIONS 252
REFERENCES 252
Evaluation of the Patient With Erectile Dysfunction 257
INTRODUCTION 257
ROUTINE PATIENT ASSESSMENT 258
ADDITIONAL TESTING 262
HEALTH BENEFITS OF ED EVALUATION 271
CONCLUSION 271
REFERENCES 271
Oral Therapy for Erectile Dysfunction 275
INTRODUCTION 275
HISTORY 275
SCIENTIFIC DISCOVERY 276
PHARMACOLOGY OF PHOSPHODIESTERASE INHIBITORS 276
PHARMACOKINETICS AND PHARMACODYNAMICS: DOSING ISSUES AND LIMITATIONS 278
SAFETY PROFILE OF PDE-5 INHIBITORS 280
DRUG INTERACTIONS AND CONTRAINDICATIONS 282
CLINICAL EXPERIENCE AND POSTMARKETING ANALYSIS 282
OPTIMIZING ORAL THERAPY: FAILURES OF PDE-5 INHIBITOR 284
PATIENT COMPLIANCE 285
PATIENT PREFERENCE ISSUES 285
FUTURE TARGETS AND HOMEOPATHIC REMEDIES 286
CONCLUSION 286
REFERENCES 287
Intracavernosal Injection of Vasoactive Agents 291
INTRODUCTION 291
HISTORY 292
ALPROSTADIL 292
PAPAVERINE 294
PHENTOLAMINE 295
COMBINATION PRODUCTS 296
NEWER AGENTS 299
PRACTICAL ISSUES ON SELF-INJECTION THERAPY (TABLE 10) 300
RELATIVE CONTRAINDICATIONS 300
MANAGEMENT OF COMPLICATIONS RESULTING FROM SELF- INJECTION THERAPY 302
CONCLUSIONS 303
REFERENCES 304
Topical and Intra-Urethral Therapy 307
INTRODUCTION 307
INTRA-URETHRAL THERAPY 308
INTRA-URETHRAL THERAPY FOR ED: BACKGROUND 308
INTRA-URETHRAL PGE1 309
GENERAL PRINCIPLES OF TOPICAL AGENTS 313
TOPICAL THERAPY FOR ED: BACKGROUND 315
TOPICAL PGE1 315
TOPICAL MINOXIDIL 317
TOPICAL PAPAVERINE 319
TOPICAL NITROGLYCERIN 321
CONCLUSION 322
REFERENCES 322
Vacuum Erection Devices 326
INTRODUCTION 326
HEMODYNAMICS OF VACUUM-INDUCED ERECTION 327
DEVICE REQUIREMENTS 328
PATIENT SELECTION 328
EFFICACY 329
PATIENT SATISFACTION AND LONG-TERM USE 330
COMPLICATIONS 331
ROLE IN TREATMENT 331
CONCLUSIONS 331
REFERENCES 332
Penile Implants 334
INTRODUCTION 334
TYPES OF PENILE IMPLANTS 335
MARKETING ERECTILE RESTORATION IN THE 21st CENTURY 342
INTERNAL MARKETING OF PROSTHETIC UROLOGY 344
EXTERNAL MARKETING FOR PROSTHETIC UROLOGY 345
PATIENT SELECTION AND INFORMED CONSENT 346
PRE-OPERATIVE PREPARATION AND POSTOPERATIVE CARE 347
INCISIONS 349
ANESTHESIA 352
OPERATIVE TECHNIQUE 353
RESULTS 359
IMPLANT REPAIR 360
SCARRED CORPORAL BODIES 361
CORPOROPLASTY: GLANS FIXATION 368
INFECTION 371
VISCUS INJURY 378
SATISFACTION 379
REFERENCES 380
Peyronie’s Disease 383
INTRODUCTION 383
CLINICAL CHARACTERISTICS AND EPIDEMIOLOGY 384
HISTOLOGICAL CHARACTERISTICS 384
ETIOLOGY 385
DIAGNOSIS 387
TREATMENT 388
ORAL THERAPY 389
LOCAL DRUG THERAPY: INTRALESIONAL AND IONTOPHORESIS 391
EXTRACORPOREAL SHOCK-WAVE THERAPY AND OTHER FORMS OF ENERGY DELIVERY 394
TREATMENT OF ERECTILE DYSFUNCTION IN MEN WITH PEYRONIE’S DISEASE 395
SURGERY 395
CONCLUSION AND PRACTICAL DISEASE MANAGEMENT 395
REFERENCES 396
Peyronie’s Disease 402
INTRODUCTION 402
ANATOMY OF THE CORPORA CAVERNOSA 403
ETIOLOGY OF PEYRONIE’S DISEASE 403
ASSESSMENT OF PEYRONIE’S DISEASE 405
SURGICAL TREATMENT OF PEYRONIE’S DISEASE 406
SURGICAL TECHNIQUE 409
PENILE PROSTHESIS IN PEYRONIE’S DISEASE 415
CONCLUSION 416
REFERENCES 416
Vascular Surgery for Erectile Dysfunction 419
INTRODUCTION 419
PENILE VASCULAR ANATOMY (FIG. 1) 419
EVALUATION OF PENILE VASCULAR PHYSIOLOGY AND ANATOMY 421
ARTERIAL RECONSTRUCTIVE SURGERY 424
COMPLICATIONS 426
VENOUS LIGATION SURGERY 426
RESULTS OF PENILE VENOUS SURGERY 427
CONCLUSIONS 430
REFERENCES 431
Priapism 435
INTRODUCTION 435
ISCHEMIC PRIAPISM 436
NONISCHEMIC (HIGH-FLOW) PRIAPISM 440
CONCLUSION 443
REFERENCES 445
Ejaculatory Disorders 446
INTRODUCTION 447
PHYSIOLOGY OF EJACULATION 447
PREMATURE EJACULATION 448
INHIBITED EJACULATION, ANEJACULATION, AND ANORGASMIA 457
RETROGRADE EJACULATION 459
OFFICE MANAGEMENT OF INHIBITED EJACULATION, ANEJACULATION, AND ANORGASMIA 460
REFERENCES 461
Gene Therapy for Erectile Dysfunction 466
INTRODUCTION 466
GENERAL STRATEGIES OF GENE THERAPY 467
GENE THERAPY WITH NOS cDNA CONSTRUCTS FOR CONDITIONS OTHER THAN ED 470
GENE THERAPY OF ED WITH NOS cDNA CONSTRUCTS 472
GENE THERAPY OF ED WITH cDNA CONSTRUCTS FOR OTHER GENES 475
FUTURE DIRECTIONS 477
REFERENCES 478
Index 483