This document provides an overview of erectile dysfunction (ED), including its definition, prevalence, causes, evaluation, and treatment options. It defines ED as the inability to obtain or maintain an erection sufficient for sexual activity. It discusses the risk factors for ED, mainly cardiovascular diseases and related conditions. For treatment, it describes lifestyle modifications and medical options like PDE5 inhibitors and testosterone replacement, as well as devices, injections, and implants. Patient education is emphasized for successful use of PDE5 inhibitors.
This document provides an overview of erectile dysfunction (ED), including its definition, prevalence, causes, evaluation, and treatment options. It defines ED as the inability to obtain or maintain an erection sufficient for sexual activity. It discusses the risk factors for ED, mainly cardiovascular diseases and related conditions. For treatment, it describes lifestyle modifications and medical options like PDE5 inhibitors and testosterone replacement, as well as devices, injections, and implants. Patient education is emphasized for successful use of PDE5 inhibitors.
This document provides an overview of erectile dysfunction (ED), including its definition, prevalence, causes, evaluation, and treatment options. It defines ED as the inability to obtain or maintain an erection sufficient for sexual activity. It discusses the risk factors for ED, mainly cardiovascular diseases and related conditions. For treatment, it describes lifestyle modifications and medical options like PDE5 inhibitors and testosterone replacement, as well as devices, injections, and implants. Patient education is emphasized for successful use of PDE5 inhibitors.
This document provides an overview of erectile dysfunction (ED), including its definition, prevalence, causes, evaluation, and treatment options. It defines ED as the inability to obtain or maintain an erection sufficient for sexual activity. It discusses the risk factors for ED, mainly cardiovascular diseases and related conditions. For treatment, it describes lifestyle modifications and medical options like PDE5 inhibitors and testosterone replacement, as well as devices, injections, and implants. Patient education is emphasized for successful use of PDE5 inhibitors.
2. Classify the risk factors for erectile dysfunction (ED) 3. Describe the medical and surgical treatment options available for erectile dysfunction 4. Describe the contra-indications and patient counselling regarding PDE-5 Erectile Dysfunction (ED): Defined
“The consistent or recurrent inability to obtain and/or maintain an erection sufficient for satisfactory sexual activity” Prevalence of ED: Massachusetts Male Aging Study
Hyperlipidemia Martin-Morales A et al. J Urol. 2001;166:569-575. Laumann EO et al. JAMA. 1999;281:537-544. Braun M et al. Int J Impot Res. 2000;12:305-311. ED: A Canary in a Coal Mine ED shares many risk factors for heart disease and warrants a cardiac risk assessment in most patients Evaluation & Diagnosis Organic (90%) Older adults
Gradual onset
Risk factors
Pervasive problem (nocturnal, intercourse,
masturbation) Psychogenic (10%) Young
Sudden onset
Absence of risk factors
Situational/intermittent problem
Nocturnal or early morning erections maintained
Psychological history Evaluation & Diagnosis
Medical, Sexual, Psychological History
Validated Questionnaire Internation Index of Erectile Function (IIEF) Sexual Health Iventory for Men (SHIM) Physical Examination HR, BP, weight/BMI
vasoconstriction > low blood flow vasodilation > high flow
Flaccid Penis Erect Penis
Patel U, Lees WR. In: Textbook of Erectile Dysfunction. 1st ed. Oxford, UK: Isis Medical Media Ltd; 1999:207-220. Mechanisms of Smooth Muscle Cell Relaxation with PDE5i Common Side Effects of PDE5i
• Headache • Dyspepsia • Rhinitis • Flushing of face/skin • Abnormal vision (Viagra) • Dizziness • Myalgias (Cialis) Carson CC, et al. Urology. 2002;60:12-27. McMurray JG, et al. Poster presented at: 10th World Congress of the International Society for Sexual and Impotence Research; September 22-26, 2002; Montreal, Canada. Contraindications to PDE5i
Absolute: Use of Nitrate medication
Relative: Contraindications to PDE5i
NOT contraindicated in patients with:
History of stable CV disease/MI (except if absolute or relative contraindications exist) Patients on alpha-blockers for BPH (historical)
Young patients with psychogenic ED (may help)
Does NOT cause priapism
Still mentioned on product monograph Patient Education – Keys to PDE-5i Success Patient Education critical to success Take 30 min in advance of sex (1 hr for Cialis)
Mental and physical stimulation required
Not a “magic” erection pill, best of partner aware Anxiety can counteract effects of medication Try medication several times Efficacy of the 3 drugs varies from patient to patient Try at least 2 drugs before declaring failure Warn patient about side-effects, and reassure them that they won’t die by taking PDE-5i Androgens and Testosterone Replacement
•May be useful in men with ED and low testosterone (esp
if other symptoms of testosterone deficiency exist i.e. low libido)
•Consider in men not responding to PDE5i
Testosterone Deficiency Syndrome
Bhasin S et al. Testosterone Therapy in Adult Men
with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline Testosterone Deficiency Syndrome
Initial Evaluation for TDS
Morning serum Total T, FSH, LH, Prolactin
PSA, CBC, DRE if considering therapy
Treatment (indicated for symptoms of TDS + Low T)
Topical Gel – 1st Line (Androgel, Testim, Axiron)
Other agents – 2nd Line (Oral, IM, Patch)
Monitoring (q3-6 months initially)
Symptom assessment and CBC, PSA, DRE MUSE Intraurethral Suppository (PGE-1) MUSE
1 Problems: 2 •Limited efficacy •Pain •Priapism
3 4 * Vacuum Erection Device
• Cumbersome • Limited efficacy • Non-pharmacologic • Can be used in patients on Ntg Intracavernosal Injection Therapy (ICI) Caverject (Alprostadil)
