Erectile Dysfunction (ED)

Last updated 25.08.13

 

Definition

-  Consistent or recurrent inability to attain &/or maintain a penile erection sufficient for satisfactory sexual activity & intercourse

 

Features

-    21% men > 40yrs report significant problems, 10% unable to achieve erections

-    Incidence

-     3% 40-49yrs

-     68% >70yrs

-    Treatable condition which if often overlooked

 

Associated S/S

-      Inability to attain &/or maintain a penile erection

 

Risk Factors

-    HTN: 50% increased risk

-    DM: 50% increased risk

-    CVS disease

-    Smoking

-    Depression

 

Cause

-    Performance anxiety

-    Sexual attitudes

-    Relationship problems

-    Social stressors

-    Depression

-    Psychiatric disorders

-    Diabetes

-    HTN

-    Obesity

-    CRF

-    Hyperlipidaemia

-    OSA

-    Athersclerosis

-    EtOH

-    Substance abuse

-    Medications

-    Spinal cord trauma

-    MS

-    Pelvic surgery/trauma

-    PD

-    Alzhiemers

-    Peyronies disease

 

Ix

-      Sexual history

-     Ability to masturbate

-     Morning erection

-      Psych history

-      Genito-urinary exam

-     Plaques: Peyronies

-     Testicular volume: androgen deficiency

-     Virilisation

-     Gynacomastia

-      CVS exam: HTN

-      Neuro exam:

-      Fasting glucose: DM

-      Fasting lipids: hyperlipidaemia

-      Serum total testosterone (morning 8-10am sample): androgen deficiency

 

Mx

-      Alter modifiable risk factors

-     Cease medications known to cause ED if possible or change dosing

-     Weight loss

-     Smoking cessation

-     EtOH reduction

-     Exercise

-     Stress reduction

-      Counselling, psychosexual therapy

-      Education

-      PDE5 inhibitors

-     Contraindications: nitrates, hypotension, cautious use in CCF

-     No effect after 2 doses then increase dose

-     Sexual arousal required for effect

-     Treatment failure after 8 trials at full dose

-     On-Demand Dosing

-    Trial with 8 tablets intially

-    Tadalafil (Cialis): 10 or 20mg Daily PRN (commence at 20mg)

-   Has slightly longer half life than other tablets

-    Verdenafil (Levitra) 5, 10 or 20mg Daily PRN (commence at 10mg, usually require 20mg)

-    Sildenafil (Viagra) 25, 50 or 100mg Daily PRN (commence at 50mg, usually require 100mg)

-     Daily Dosing

-    Tadalafil (Cialis) 5mg Daily

-    Consider if using on demand 2+ per week or anxiety associated with timing or dosing and sexual activity

-      Vacuum constrictors & rings

-      Referral: ED specialist, Urologist, Endocrinologist

-     Intracavernous injections (Alrpostadil = Caverject Impulse)

-    Max 3/week with 24hrs+ between uses

-    Erection 5-15 min post injection

-    Need plan to manage priapism

-     Penile prosthesis

-     Vascular surgery

 

 

 

References

 

Andrology Australia: Erectile Dysfunction