ED & MENOPAUSE

• Menopause

  Also known as "climacteric or change of life"
• Menopause

  • Average age is 51
  • The end of menstruation. Usually 2 consecutive months without menses
  • Perimenopause includes premenopause, menopause and at least 1 year after menopause. Post menopause refers to the phase after menopause, when menstrual periods have ceased all together
  • It is a combination of endocrine (estrogen), body, and psychological changes that occur at the end of the reproductive cycle
  • A state of estrogen deficit can result in bone loss (osteoporosis)
• Menopause symptoms


  • Impaired sleep
  • LDL increases/HDL decreases
  • Hot flashes/night sweats
  • Increased risk of osteoporosis
  • Headaches
  • Memory changes
  • Decreased sex drive
  • Skin & vaginal dryness
• Psychological symptoms of menopause

  • Grief/loss
  • Mood swings
  • Irritability
  • Depression
• Menopause hormone therapy (MHT)


  • Estrogen and progesterone are given to the woman who still have a uterus.
  • Estrogen to those who have had a hysterectomy
• Adverse effects of MHT

  • Increased risk for breast and uterine cancers
  • Clots and stroke
• Other options for menopause therapy

  • Water soluble vaginal lubricants
  • Botanical preparations
  • Kegel exercises
  • Drinking 8 glasses of water daily
  • Wiping front to back to reduce transfer of bacteria
• Organic erectile dysfunction (ED)

  Gradual deterioration of function
• Causes of organic ED

  • Vascular disease
  • Endocrine disease
  • Neurologic disease
  • Chronic disease
  • Penile disease or trauma
  • Surgery
  • Pharmaceutical therapy
  • Obesity
• Causes of psychogenic ED

  • Anxiety
  • Privacy
  • Depression
  • Fatigue
  • Trust
  • Negative body image
• Oral Phosphodiesterase-5 inhibitors (PDE5)


  Relaxes the smooth muscle in the corpora cavernosa so blood flow increases to penis
• PDE5 inhibitors

  • Sildenafil (Viagra)
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)
• No grapefruit and no nitrates with PDE5 inhibitors
• Side effects of PDE5 inhibitors

  • Flushing
  • Headache
  • Hypotension
  • Dyspepsia
  • Priapism