Feature Article

Erectile dysfunction. Part 1: Patient assessment and treatment options



© PAolEsE/stocK.AdoBE.coM ModEls usEd for illustrAtiVE PurPosEs only
© PAolEsE/stocK.AdoBE.coM ModEls usEd for illustrAtiVE PurPosEs only


Erectile dysfunction (ED) may be an early manifestation of generalised endothelial dysfunction and a predictor of other forms of cardiovascular disease, suggesting a need for screening. ED treatments include oral medications, intracavernous injection pharmacotherapy, vacuum constriction devices and penile prostheses, alone or in combination with graded levels of psychosexual counselling.

Key Points

  • Erectile dysfunction (ED) is common and can be treated pharmacologically in most men.
  • ED may be a predictor and a precursor of other forms of cardiovascular disease morbidity and mortality.
  • The patient’s cardiovascular status and overall fitness for renewed sexual activity should be assessed before initiation of ED treatment.
  • Oral phosphodiesterase-5 (PDE5) inhibitors are effective in 65 to 70% of men with ED; their efficacy is significantly reduced in patients with severe vasculogenic ED, diabetic ED and ED after radical prostatectomy.
  • Alprostadil is the drug of first choice for self- administered intracavernous injections and is effective in 70% of men with ED, with a low risk of priapism and penile fibrosis.
  • Intrapenile prostheses are effective treatments in men with ED unresponsive to pharmacotherapy.