impotence
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Introduction
Sexual dysfunction in a male.
Etiology
- endocrine
- testicular failure (hypogonadism)
- primary
- secondary
- hyperprolactinemia
- diabetes mellitus
- testicular failure (hypogonadism)
- pharmacologic agents[4]
- androgen antagonists
- estrogen
- antihypertensive agents
- centrally acting sympatholytics
- peripherally acting sympatholytics
- beta-adrenergic receptor antagonists (beta blockers)
- calcium channel blockers
- thiazide diuretics
- digoxin
- anticholinergic agents
- antihistamines (H1 receptor antagonists)[2]
- dimenhydramine, diphenhydramine, hydroxyzine, meclizine, promethazine
- antidepressants
- monoamine oxidase (MAO) inhibitors
- tricyclic antidepressants (TCA)
- selective serotonin receptor antagonists
- selective norepinephrine reuptake inhibitors
- antipsychotic agents
- central nervous system depressants
- drugs of habituation or addiction
- anticonvulsants
- corticosteroids
- statins ?[3]
- NSAIDs - naproxen, indomethacin[2]
- Parkinsonian agents
- levodopa, bromocryptine, biperiden, trihexyphenidyl, benztroine, procyclidine[2]
- 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
Epidemiology
- 5% of men at 40 years of age
- 15% of men at 70 years of age
Laboratory
- serum chemistries
- serum glucose
- 8 AM serum testosterone, free testosterone*
- serum FSH & serum LH if two 8-10 AM serum testosterone or free testosterone are low
- serum prolactin
- serum luteinizing hormone
- serum urea nitrogen
- serum creatinine
- hemoglobin A1c
* free testosterone may be necessary in obese due to lower sex hormone-binding globulin in serum thus total serum testosterone[2]
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]
- yohimbine widely prescribed, but works only as placebo in psychogenic impotence
- injection of prostaglandin E2 (alprostadil)
- commercially available mechanical devices
- penile prosthesis - highest rate of complications
- treatment of specific etiology
- prolactinoma
- surgical correction of arterial disease
- control of diabetes
- reduce or refrain from alcohol
- psychotherapy for dysfunctional relationships, anger, depression
More general terms
More specific terms
References
- ↑ 1.0 1.1 Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 286
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2022
- ↑ 3.0 3.1 Rizvi, K et al, Do lipid-lowering drugs cause erectile dysfunction? A systematic review Family Practice 2002, 19:95 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11818357
Pedersen TR & Faergeman O Simvastatin seems unlikely to cause impotence. BMJ 1999, 16:318 PMID: https://www.ncbi.nlm.nih.gov/pubmed/9888926
Halkin A et al, HMG-CoA reductase inhibitor-induced impotence. Ann Pharmacother 1996, 30:192 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8835058 - ↑ 4.0 4.1 Prescriber's Letter 13(9): 2006 Drugs That May Cause Male Sexual Dysfunction Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220907&pb=PRL (subscription needed) http://www.prescribersletter.com