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Erectile Dysfunction

Definition of Erectile Dysfunction (ED)

"The inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance" (NIH Consensus Development Panel on Impotence)

Prevalence of ED

Approximately 5% of men at age 40, increasing to 15% - 25% by age 65

Prevalence increases with age, but ED is not an inevitable and untreatable consequence of aging

Causes of ED

Diagnosis of ED: History

Detailed sexual and medical history, including:

Nature and frequency of ED

Risk factors for ED, eg:

Concurrent disease

Drug abuse

Psychiatric illness

Risk Factors for ED

Drugs Associated with ED

Diagnosis of ED: Physical Examination

Laboratory Tests

Complete blood count

Special Tests: Indications

Screen for psychogenic vs organic ED

Vascular surgery

Treatment Options for ED

Hormonal Therapy

Vacuum Constriction Devices

Transurethral Alprostadil (MUSE)

Approximately 2/3 of patients using the active drug had sexual intercourse (compared to 19% with placebo)

The efficacy of transurethral alprostadil did not differ significantly depending on the etiology of the ED

Penile pain was reported for 10.8% of alprostadil administrations and by 32.7% of men

Only 2.4% of men discontinued because of pain

Vasoactive Intracavernosal Pharmacotherapy

Relaxes cavernous and arterial smooth muscle

Oral Pharmacologic Treatments

Sildenafil

Nitric oxide acts through a second messenger, cGMP, in the normal development of erections

cGMP relaxes corpus cavernosal smooth muscle cells, promoting blood flow into cavernosal spaces

cGMP broken down by PDE - the predominant enzyme of this type inthe corpus cavemosum is PDE type V

Sildenafil is a selective and potent inhibitor of PDE type V

Three UK clinical trials (N=12; N=42; N=351)

Apomorphine

Central dopamine receptoragonist

Causes a well-recognized erectile response in rats

Phentolamine

Penile Implants

Vascular Surgery