Erectile%20dysfunction Management

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, and steroids

Sexual Counseling and Education

• Encompass sex therapy, psychosocial therapy, and marital therapy
• May be appropriate for patient and/or partner
• May be used to address and correct relationship issues, stress factors (eg work, finances, family, etc)
• Decreased sexual drive may be due to psychologic issues and 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 and education may be preferred by patients/partners because it is noninvasive and has broad applicability

• Patients receiving phosphodiesterase inhibitors must have regular follow-up of efficacy, side effects, and any relevant change in their health status (especially cardiovascular health) including medications
• Failure to respond to phosphodiesterase inhibitor may be due to: 
  • Hormonal abnormalities
  • Drug interactions
  • Food interference with absorption
  • Timing and frequency of dosing
  • Lack of adequate sexual stimulation
  • Heavy alcohol use
  • Patient’s relationship with 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 with other more invasive therapies for erectile dysfunction