Evaluation and Medical Management of Erectile Dysfunction

The American Journal of the Medical Sciences, 1995

with aging, which resulted in little attention being given to sexual behavior and treatment of sexual dysfunctions in the older population. However, in the current era it is known that as life expectancy improves, both men and women are seeking to preserve their sexuality into old age. While the appreciation of sexuality persists with aging, a decline in sexual activity is typically seen with, and can be attributed to both general health problems as well as specific sexual dysfunctions. In a large US study, the proportion of males who were sexually active declined from 83.7% in the age group 57-64 years to 38.5% in the age group 75-85 years . In a smaller pilot study in a cohort of 50 patients with a mean age of 81 years, Smith et al. reported that the main reason for being sexually inactive in older men was erectile dysfunction (ED), the condition defined as the persistent inability to attain and maintain penile erection sufficient for sexual intercourse . It is likely the most thoroughly studied sexual dysfunction in men and the most common sexual complaint of men presenting to their healthcare providers . The advent of safe oral therapy for the treatment of ED has brought attention to the disease and likely results in increased treatment-seeking behavior, also in the aging male. Despite the overwhelming success of these oral phosphodiesterase-5 inhibitors (PDE5I), the demand for pharmacotherapeutic and surgical options for ED continues to rise as a result of the increased proportion of elderly in the population as well as the increasing recognition that approximately one

International Journal of Endocrinology, 2014

Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.

Erectile dysfunction (ED) is common with aging. Formerly ED treatment was offered mainly by urologists, but the approval and widespread use of phosphodiesterase inhibitors has enabled primary care clinicians to provide targeted ED treatment. Although large, multicenter clinical trials have shown efficacy and safety with these drugs, they are ineffective in 30-35% of men, may cause sideeffects, and do not improve the underlying pathology. A thorough understanding of erectile physiology and causes of ED and a comprehensive treatment plan addressing all contributing factors may be more effective than pharmaceutical management and may improve aspects of psychological and physical health beyond erectile problems.

Asian Journal of Pharmaceutical and Clinical Research

It has been estimated that currently over 150 million men worldwide suffer from erectile dysfunction (ED) and by 2025, the figure will increase beyond 322 millions. ED is the inability to achieve, and/or maintain penile erection sufficient for satisfactory sexual intercourse, and was previously regarded as the part of aging. It is associated with certain diseases and life style habits with a cause-effect relationship, including diabetes mellitus, hypertension, dyslipidemia, and cigarette smoking. Internationally, most of the men with ED fail to pursue treatment due to the complex nature of sexuality, taboos, cultural restrictions, and acceptance of ED as a normal sequel of aging. In this review, we discussed the physiology, diagnosis, and risk factors associated with ED and current treatment strategies for ED.Keywords: Erectile dysfunction, Diabetes, Penile erection, Phosphodiesterase inhibitors.

Urology journal, 2004

According to a survey, the Massachusetts Male Aging Study, 52% of men beyond 40 years of age may have some degrees of erectile failure, and it is projected to affect 322 million men worldwide by 2025. We present a framework for the evaluation, treatment, and follow-up of the male patient who presents with erectile dysfunction. A comprehensive review of the literature was conducted using the MEDLINE database for all articles from 1975 through 2004 on male sexual dysfunction and the most pertinent articles are discussed. Remarkable progress has been made in the treatment of erectile dysfunction (ED). Erectile dysfunction is a common condition associated with aging, chronic illnesses and various modifiable risk factors. Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, and/or psychogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate pathway or other regulatory mechanisms. The number of consultations from new patients presenting w...

The American Journal of Medicine, 2000

During the last decades, erectile dysfunction was considered a direct consequence of aging and, although of a great concern for the affected patient, little was available to evaluate and treat this problem. If aging could not be invoked in all cases, than the psychogenic etiology was the only explanation. Over the coming years, a better understanding of the physiology involved in the penile process of tumescence and detumescence has allowed for better approach of each disease asociated with erectile dysfunction so that adequate treatment modalities can be applied to the pacient. As we all know, every pacient is a particular case. The development of modern PDE-5 inhibiters, along with other more or less invasive therapies, puts a new light on the medical approach of ED.

2006

Erectile dysfunction (ED) has multifactor pathogenesis, with neurological, vascular, endocrinological and psychogenic components described. However, about 50-85% of ED population report the presence of one or more comorbidities i.e. hypertension, diabetes, cardiovascular disease, dyslipidemia which all impair endothelial function and, erection is a basically vascular event that necessitates an intact endothelium to occur. Hence, ED may be mostly considered as the clinical manifestation of a disease affecting penile circulation as a part of a generalized vascular disorder due to atherosclerosis. Orally active drugs, i.e. phosphodiesterase type-5 inhibitors (PDE5-i), are a group of on-demand drugs licensed for ED treatment and appear to offer advantages over past therapies in terms of ease of administration and cost, and they are now widely advocated as first-line therapy. The recent discovery that chronic not on-demand administration of these drugs may improve erectile and endothelial response in men previously unresponding to on-demand regimes, opens a new scenario in the treatment of men with ED and comorbidities. Finally, the recent approval of PDE5-i sildenafil for the treatment of pulmonary arterial hypertension represents the new challenge for these class of drugs. Aim of this article will be to provide an update on the pathophysiology of ED and how to use of different available PDE5-i in approaching sexual dysfunctional men, pointing out on their characteristic of efficacy and safety and different indications in special subpopulations.

Annals of Pharmacotherapy, 2005

Urological Science, 2013

Erectile dysfunction (ED) is one of the most common sexual disorders in men, and the existence of an underlying cause should always be considered. It is also commonly and closely associated with age and risk factors for cardiovascular disease. Therefore, all men with ED should be screened for medical problems. Treatment of ED can enhance self-esteem, reduce psychological morbidity, and increase the emotional well-being of both partners. Today, unless contraindicated, user-friendly, effective, and safe therapies offered for the treatment of ED are lifestyle and risk factor modification (e.g., exercise and weight loss) and the use of oral phosphodiesterase type 5 inhibitors, such as sildenafil, tadalafil, or vardenafil. Vacuum erection devices, intracavernous injection therapy, and penile prostheses are other options of treatment when oral medication fails. The following minireview provides a practical approach for the management of ED in outpatient departments.

Postgraduate Medical Journal, 2017