Erectile dysfunciton

Question 1

What are the risk factors of Erectile dysfunction? (8)

Answer 1

Biopsychosocial.

Medical: diabetes**, smoking**, alcohol**, cardiovascular/PVD, prostate, hypogonadism, drugs.

Psycho: mood disorders

Social: patient & partner factors / relationships

Question 2

How would you investigate for erectile dysfunction? (3)

Answer 2

Testosterone

Prolactin

BSL for diabetes

Question 3

How would you manage this patient’s erectile dysfunction?

Answer 3

Identify and treat underlying endocrinopathies, depression, anxiety

Non-pharm

• Counselling
• Education: both patient & partner - drugs may take sometime to work, ETOH/Smoking → poor results, importance of exercise, still needs sexual stimulation for drugs to work.
• Exercise
• Smoking cessation**
• Alcohol cessation**
• Vacuum device
• Penile prosthesis

Pharm (only 50% success rates)

• Sildenafil (PDE5 inhibitor) - caution with IHD, don’t use with nitrates, 30min before sex, 25mg OD to 100mg OD
• Tadanafil (longer acting)
• Intra-cavernosal injections (vasodilator)