Skip to Main Content

++

PATIENT CARE PROCESS

++

Patient Care Process for the Management of Erectile Dysfunction

Image not available.

Collect

  • Patient characteristics (e.g., age, race)

  • Patient history (past medical history, marital/partner status, family history, social—sexual history, situations in which erectile dysfunction occurs; tobacco, recreational drug, or alcohol use)

  • Administer International Index of Erectile Function screening questionnaire if feasible (see Diagnosis section)

  • Current and past medications, including prescription and nonprescription medications, or nonpharmacologic interventions for erectile dysfunction (see Table 83-4)

  • If patient is not responding to a phosphodiesterase type 5 inhibitor, details on how and when patient is using the medication (see Phosphodiesterase Type 5 Inhibitor Efficacy section)

  • Current psychologic status (emotional stressors, depression, performance anxiety) (see Clinical Presentation box)

  • Objective data (see Diagnosis section)

    • Blood pressure, heart rate, height, weight, and BMI

    • Physical examination to rule out hypogonadism and prostate dysfunction

    • Labs (e.g., blood/serum glucose, lipids, testosterone)

    • Cardiovascular risk assessment, if indicated (see Diagnosis section and Table 83-3)

Assess

  • Patient and partner's expectations regarding therapy and costs

  • Patient's physical ability to engage in or contraindications to sexual intercourse

  • Presence contraindications to phosphodiesterase type 5 inhibitors (see Table 83-3)

  • Current use of medications contributing to erectile dysfunction (see Table 83-2)

Plan*

  • Optimize treatment for underlying causes of erectile dysfunction (e.g., hypertension, coronary artery disease, dyslipidemia, diabetes mellitus, smoking, chronic ethanol abuse)

  • Discontinue medications contributing to erectile dysfunction when possible (Table 83-2)

  • Treat hypogonadism when present

  • Psychotherapy for psychogenic causes of erectile dysfunction

  • Drug therapy regimen including specific agent(s), dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 83-4 and 83-5 and Figures 83-2 and 83-5, 83-6, 83-7)

  • Nonpharmacologic or surgical intervention when medications are contraindicated or are not effective (see Figures 83-2 and 83-3)

  • Patient re-education if nonresponsive to phosphodiesterase type 5 inhibitor, if appropriate (see Phosphodiesterase Type 5 Inhibitor Efficacy section)

  • Monitoring parameters including efficacy (e.g., BP, cardiovascular events, kidney health), safety (medication-specific adverse effects), and timeframe (see Tables 83-6 and 83-7)

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Referrals to other providers when appropriate (e.g., physician, urologist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Schedule follow-up for several weeks after therapy initiation

Follow-up: Monitor and Evaluate

  • Patient satisfaction with quality and quantity of penile erections

  • Presence of adverse effects

  • Adjust medication doses or change to alternative agent as clinically indicated

*Collaborate with patient, caregivers, and other health professionals

++

KEY CONCEPTS

++

KEY CONCEPTS

  • Image not available. The incidence of erectile dysfunction is low in men younger than 40 years of age. The incidence increases as men age likely as a result of concurrent medical conditions that impair the vascular, neurologic, psychogenic, and hormonal systems necessary for a normal penile erection.

  • Image not available. Many commonly used drugs have sympatholytic, anticholinergic, sedative, or antiandrogenic effects that may exacerbate or contribute to the development of erectile dysfunction. Clinicians should be familiar with these ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.