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Erectile Dysfunction

Erectile dysfunction should be evaluated by taking a careful medical history (with attention to cardiovascular disease, diabetes or other features of the metabolic syndrome, manifestations of hypogonadism, previous pelvic surgery or trauma, and medications) and physical examination, looking for evidence of underlying disorders such as hypogonadism and vascular disease. Limited laboratory testing is recommended, including the measurement of testosterone, glucose, and lipid levels. Switching from a medication that is associated with erectile dysfunction to an alternative that is not should be considered. In the case in the vignette, for example, the beta-blocker might be changed to an angiotensin-converting–enzyme inhibitor in order to assess whether the patient’s symptoms would improve in the absence of the beta-blocker. In addition, weight loss and exercise should be recommended, and smokers should be counseled to discontinue.

The selection of specific treatments should involve both the patient and his partner. In the absence of contraindications to the use of phosphodiesterase type 5 inhibitors (e.g., the use of nitrates or a history of priapism), these agents are generally prescribed as first-line therapy. Injection and device therapies should be reserved for patients who do not have a response to phosphodiesterase type 5 inhibitors or in whom these drugs are contraindicated or poorly tolerated (i.e., about a third of men who receive such drugs). Psychosexual counseling may be helpful in cases of erectile dysfunction with psychogenic or social components.

This entry was posted on Saturday, December 15th, 2007 at 2:23 pm and is filed under Erectile Dysfunction Pills, News. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.