erectile%20dysfunction
ERECTILE DYSFUNCTION

Erectile dysfunction is the inability to attain and maintain an erection enough to have satisfactory sexual performance for ≥3 months.

It is when the patient complains of partial erection that could not attain vaginal penetration.

Complete loss of penile rigidity is uncommon.

Initial penile erections can penetrate but early detumescence occurs without ejaculation.

Prevention

Treat Psychosocial Factors

  • Confronting depression or substance abuse
  • Sexual education/correction of misinformation

Discontinue Offending Medications

  • Many common medications may affect male sexual function
    • Eg antidepressants, antipsychotics, anti-arrhythmics, many antihypertensives, anti-androgens & steroids

Counselling

Sexual Counseling & Education

  • Encompass sex therapy, psychosocial therapy & marital therapy
  • May be appropriate for patient &/or partner
  • May be used to address & correct relationship issues, stress factors (eg work, finances, family, etc)
  • Decreased sexual drive may be due to psychologic issues & individual may benefit from sexual therapy
  • Use as adjunct to other erectile dysfunction therapy to address patient’s psychological reaction to their need for erectile dysfunction treatment
  • Sexual counseling & education may be preferred by patients/partners because it is noninvasive & has broad applicability

Follow Up

  • Patients receiving phosphodiesterase inhibitors must have regular follow-up of efficacy, side effects & any relevant change in their health status (esp CV health) including medications
  • Failure to respond to phosphodiesterase inhibitor may be due to: 
    • Hormonal abnormalities
    • Drug interactions
    • Food interference w/ absorption
    • Timing & frequency of dosing
    • Lack of adequate sexual stimulation
    • Heavy alcohol use
    • Patient’s relationship w/ his partner
  • A patient who fails initial trial of phosphodiesterase inhibitor (after above factors are modified) may be given a different phosphodiesterase inhibitor or proceed w/ other more invasive therapies for erectile dysfunction
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