- 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.
- 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 agents and be prepared to make adjustments in drug regimens to minimize adverse effects of these drugs on a patient's erectile function.
- The first step in clinical management of erectile dysfunction is to identify and, if possible, reverse the underlying causes. Risk factors for erectile dysfunction, including hypertension, diabetes mellitus, smoking, and chronic ethanol abuse, should be addressed and minimized.
- Specific treatments for erectile dysfunction include vacuum erection devices, pharmacologic treatments, psychotherapy, and surgery.
- The ideal treatment of erectile dysfunction should have a fast onset, be effective, be convenient to administer, be cost effective, have a low incidence of serious adverse effects, and be free of serious drug interactions.
- Specific treatment is first initiated with the least invasive forms of treatment, including vacuum erection devices or oral phosphodiesterase inhibitors, followed by intracavernosal injections or intraurethral inserts, and finally by surgical insertion of a penile prosthesis.
- Vacuum erection devices can have a slow onset of action (30 minutes) and are not discreet; therefore, they are most effective for a couple in a stable relationship.
- Although phosphodiesterase inhibitors are convenient and effective regardless of the etiology of erectile dysfunction, they fail in 30% to 40% of patients. Also, phosphodiesterase inhibitors are contraindicated in patients taking any dosage formulation of nitrate.
- Testosterone supplementation should be reserved for patients with primary or secondary hypogonadism who have erectile dysfunction as a consequence of a decreased libido. Testosterone supplementation should not be used by patients with erectile dysfunction who have normal serum testosterone levels.
- Although intracavernosal injections and intraurethral pellets of alprostadil are effective independent of the etiology of erectile dysfunction, they fail in one third of patients. To self-administer medication by these routes, patients require training to minimize administration-related adverse effects.
Upon completion of the chapter, the reader will be able to:
- 1. Describe the pathophysiology of erectile dysfunction
- 2. Describe the role of a patientâs medical history, physical exam findings, lab studies, and other diagnostic studies in the appropriate evaluation of erectile dysfunction
- 3. Identify the goals of therapy for treatment of erectile dysfunction
- 4. Explain the mechanism, indications, common dosing regimens, and adverse effects of vacuum erection devices, phosphodiesterase inhibitors, and intracavernosal injection therapy for erectile dysfunction.
- 5. Select an appropriate treatment regimen and monitoring parameters to assess the efficacy and safety of treatment for a patient with erectile dysfunction
- 6. Describe the role of combination therapy for erectile dysfunction
- 7. Explain the role of testosterone supplementation in patients with sexual dysfunction
The National Institutes of Health Consensus Development ...