Erectile Dysfunction

Background

Management

Special circumstances: post-surgical ED

PDE-5 contraindications:

PDE-5 not recommended (or use only with caution) in:

Background

Erectile dysfunction has organic and non-organic causes. Non-organic psychological causes can be managed by referral to a specialised psychologist.

If an organic cause is suspected, it is worth considering the co-existence of cardiovascular disease, and investigating appropriately. Investigation for diabetes is also worth considering.

Management

Most patients with ED can be managed in primary care with PDE-5 inhibitors (please see contra-indications and cautions, below). For patients with contraindications, please refer. For patients with ED not responding to PDE-5 inhibitors, please refer if they want further management. Generally, patients should try an oral tablet on eight separate occasions before response to oral therapy is considered to have failed.

Other options are available after failed oral treatment, including:

• Penile injection therapy
• Vacuum assistance device
• Penile prosthesis

Special circumstances: post-surgical ED

ED after prostate, bladder neck, or pelvic surgery can be difficult to treat and early referral is helpful.

PDE-5 contraindications:

• Cardiovascular disease that is severe enough to limit sexual activity
• Treatment with nitrates

PDE-5 not recommended (or use only with caution) in:

• Patients who have had an MI in the last 90 days
• Patients who have had a stroke in the last 6 months
• Patients with unstable angina, or angina during intercourse
• Patients with NYHA Class II (or greater) heart failure
• Patients who have a systolic BP <90mmHg or >170mmHg
• Patients with left ventricular outflow obstruction
• Patients with a history of priapism
• Patients with a history of platelet or bleeding disorders.