Erectile%20dysfunction Signs and Symptoms

Signs and Symptoms

Definition

Inability to attain and maintain an erection sufficient for satisfactory sexual performance
Prevalence increases with age as sexual activity decreases

Etiology

Increasing evidence have shown that erectile dysfunction (ED) can be an early manifestation of coronary artery and peripheral vascular disease

Signs and Symptoms

Complete loss of penile rigidity is uncommon
A patient may complain of partial erection that could not attain vaginal penetration
Initial penile erections can penetrate but early detumescence occurs without ejaculation
Nocturnal penile tumescence
Inability to maintain erection during private masturbation and/or erections related to erotic materials or other partners

Risk Factors

ED has common risk factors with cardiovascular (CV) diseases and may be the first presentation of an underlying medical condition (eg hypertension, diabetes mellitus)
Studies have shown that ED has been associated with lower urinary tract symptoms, benign prostatic hyperplasia (BPH), sexual dysfunction regardless of age, pelvic trauma, surgery, radiation, other comorbidities, and various lifestyle factors

Comorbidities and Risk Factors Associated with ED:
Vasculogenic

Diabetes mellitus
CV disease (eg hypertension, coronary artery disease, peripheral vascular disorders)
Hyperlipidemia and metabolic syndrome
Recreational habits (eg drug and/or alcohol abuse, heavy smoking)
Lack of regular physical exercise
Obesity
Major pelvic and prostate surgery (eg radical prostatectomy) or radiotherapy (pelvis or retroperitoneum)

Neurogenic

Degenerative disorders (eg multiple sclerosis, Parkinson’s disease, multiple atrophy)
Spinal cord trauma or diseases
Stroke
Central nervous system tumors
Chronic renal failure, chronic liver failure
Polyneuropathy
Surgery of the urethra (eg urethral stricture, open urethroplasty)

Endocrine

Hypogonadism/testosterone deficiency
Hyperprolactinemia
Hyper- and hypothyroidism

Psychiatric and Psychogenic

Depression
Anxiety disorders
Relationship issues
Stress
Performance anxiety
Loss of attraction

Drugs

Antiandrogens (eg Finasteride)
Antihypertensives (beta-blockers, Spironolactone, Methyldopa, thiazide diuretics)
Narcotics
Cimetidine
Antidepressants
Tranquillizers
Others (eg Clonidine, Guanethidine and Ketoconazole)

Penile Disorders

Hypospadias, epispadias, miropenis
Peyronie’s disease
Severe phimosis

Others

Obstructive sleep apnea
Sedentary lifestyle

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Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.