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Male Sexual function & Ageing

From Mediwikis

Male Changes

Testosterone

  • Loss of leydig cells
  • Loss of LH response
  • Decreased tissue response to testosterone
  • Decreased sexual function
  • Mood changes
  • Fatigue/ sleep disturbance
  • Decrease in muscle, increase in fat
  • Decrease bone mineral density
  • Decrease Haemoglobin

Fertility

  • Continued division of germ cells
  • Effects of ageing are variable
  • Reduced sertoli function- primary spermatocytes maturation arrest
  • Not really decrease pregnancy rates

Prostate Function

  • Reduced secretion of seminal plasma, decrease ejaculation volume, change in viscosity of semen, reduced *force of ejaculation
  • PBH (70% at 70)
  • Malignancy (3% at 70)

Sexual Function

  • Decreased desire
  • Prolonged arousal
  • Decreased penile sensitivity
  • Reduced rigidity
  • Decreases orgasm intensity
  • Increased refractory period

Erectile Dysfunction

  • Loss of input- psychogenic, neurogenic
  • Smooth muscle dysfunction- toxins and diabetes
  • Vascular disease- large vessel (PVD) medium vessel (IHD)
  • In normal there is dilation and engorgement of sinusoids of corpus cavernous in ED there is failure of dilation and relation.

Treatment:

  • Central Acting Drugs:
    • Apomorphine (dopamine agonist) – not any more
    • Melanocortin agonists
  • Smooth Muscle Relaxants:
    • Phospohodiesterase 5 inhibitors
      • Sildenafil
      • Tadalofil
      • Vardenafil
    • Stops dehydration of cGMP in smooth muscle cells of corpus cavernous