Erectile and ejaculatory disorders

Meet the patient

A 54-year-old man, eight weeks after a myocardial infarction, is referred by his GP for "anxiety about sex". He has not been able to get an erection since the MI, avoids the topic with his wife, and has started sleeping in the spare room. He is convinced the exertion will kill him. His HbA1c, never checked before the stent, comes back elevated.^[2][6]

This is leaf examiner uses to test three things at once: phase mapping (is this erection or ejaculation?), safety (the nitrate question is never far away), and the cardiovascular hidden curriculum — because ED is often the first presentation of endothelial disease, and sildenafil without checking the sugars and lipids is a missed diagnosis.^[3][6]

References14ShowHide

1. [1]Laumann EO, Paik A, Rosen RC Sexual dysfunction in the United States: prevalence and predictors JAMA, 1999.PMID 10022110
2. [2]McCabe MP, Sharlip ID, Lewis R, et al. Incidence and Prevalence of Sexual Dysfunction in Women and Men: A Consensus Statement from the Fourth International Consultation on Sexual Medicine 2015 J Sex Med, 2016.PMID 26953829
3. [3]McCabe MP, Sharlip ID, Lewis R, et al. Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015 J Sex Med, 2016.PMID 26953830
4. [4]Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction Urology, 1997.PMID 9187685
5. [5]Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group N Engl J Med, 1998.PMID 9580646
6. [6]Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline J Urol, 2018.PMID 29746858
7. [7]Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE) J Sex Med, 2014.PMID 24848686
8. [8]Waldinger MD, Schweitzer DH Differences between ICD-11 MMS and DSM-5 definition of premature ejaculation: a continuation of historical inadequacies and a source of serious misinterpretations by some scientists Int J Impot Res, 2019.PMID 30659291
9. [9]Pryor JL, Althof SE, Steidle C, et al. Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials Lancet, 2006.PMID 16962882
10. [10]Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients J Clin Psychiatry, 2001.PMID 11229449
11. [11]Serretti A, Chiesa A Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis J Clin Psychopharmacol, 2009.PMID 19440080
12. [12]Montejo AL, de Alarcón R, Prieto N, et al. Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach J Clin Med, 2021.PMID 33467621
13. [13]Bancroft J, Graham CA, Janssen E, Sanders SA The dual control model: current status and future directions J Sex Res, 2009.PMID 19308839
14. [14]Clayton AH, El Haddad S, Iluonakhamhe JP, et al. Sexual dysfunction associated with major depressive disorder and antidepressant treatment Expert Opin Drug Saf, 2014.PMID 25148932