Severity : satisfaction , rigidity , penetration

Iief , shim quistionnair : 5 components

Lipid , teteterone , fasting glucose
If …….. Hba1c
If tetesterone low …….

Dopller us ( venous leak , peak systolic and diastolic velocity , >20 is arterial )
Resistive index >1 normal if lower means venous leak

Types : organic and physco

Stepwise management ?
- Lifestyle changes ( d iet
- Psychosocial therapy
- Medication changes
- Hormonal
- Oral medication
- Muse ( SE : of alprostadil : pain , expensive | papafavir : fibrosis ,priapism |
phentolamine : ) mixture is to decrease SE
- Intracavernousal inj ( phentolamine : non selective a blocker )
- Mechanical : Vacuum ( numbness , no ejaculation or orgasm ) , ring constriction device
- Surgical : maleable and inflatable ( 2 and 3 pieces latter has reservoirs ) , 3 parts of
inhibison ? antibiotics in AMS rifampicin and

Anti htn worsen : thiazide and non selective B blocker

Improve: a blocker , ?ACE

Worsens : ranidiver for HIV ( protease inh ) we decrease dose to improves , rifampin we
increase dose to improve

Oral meds? PDE5 inhibiters like : papavarin ( 1-5 ) , sildanafel , tadalafil , alprostadil ( action? )

prostaglandins types E for erection and F flaccidity

Instructions before taking PDE5 inhibitors

- contraindication .** table in campel .severe lv dysfunction , NG , aortic disease , arrythmia
Relative : MI , stroke ( 6 monsths ) , renal failure with HD ,

SE: visual ( with sildenafil affect receptor 6 in retina ) , back pain ( with tadalafil affect receptor
11 in vertebra )
*Tadalafil with full stomach

Tetseterone : in hypogonadism , routes : oral like buccal , injections like : IM , Patche