Male Reproductive Dysfunction
Distinguishing Impotence (Erectile Dysfunction) vs. Sterility
1. Erectile Dysfunction (Impotence)
Definition: Inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse.
| Etiology | Examples |
|---|---|
| Psychogenic | Performance anxiety, relationship issues, depression. |
| Vascular | Diabetes mellitus, hypertension, and atherosclerosis (the most common organic causes). |
| Neurological | Multiple sclerosis, spinal cord injury, and diabetic neuropathy. |
| Endocrine/Drugs | Hypogonadism, SSRIs, antihypertensives, and alcohol. |
2. Male Sterility (Infertility)
Definition: Inability to procreate. Often categorized by the site of the defect:
- Pre-testicular: Hypothalamic/Pituitary disorders (e.g., Kallmann syndrome, hyperprolactinemia).
- Testicular: Chromosomal (Klinefelter syndrome, 47, XXY), Cryptorchidism, Mumps orchitis, Varicocele, Trauma.
- Post-testicular: Obstructive causes (e.g., Vasectomy, Congenital Bilateral Absence of the Vas Deferens – CBAVD seen in Cystic Fibrosis).
3. NEET PG High-Yield Pearls
- Diagnostic Clue: Presence of nocturnal penile tumescence (morning erection) strongly favors psychogenic erectile dysfunction.
- Seminal Fluid Analysis (SFA): The gold standard for sterility. Parameters include count, motility, morphology, and volume (WHO criteria).
- Common Medication Side Effect: SSRIs (Selective Serotonin Reuptake Inhibitors) are frequently associated with delayed ejaculation and ED.
- Clinical Correlation: A patient with retrograde ejaculation may have normal erectile function but appear “sterile” because semen enters the bladder rather than the urethra.