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Erectile Dysfunction: Evaluation and New Treatment Options

From the Division of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Address correspondence and reprint requests to Culley C. Carson, MD, Division of Urology, School of Medicine, University of North Carolina at Chapel Hill, 427 Burnet-Womack Building, Campus Box 7235, Chapel Hill, NC 27599-7235. E-mail: Carson{at}med.unc.edu

ABSTRACT

OBJECTIVE: Erectile dysfunction (ED) is a common condition of aging men. Indeed as many as 50% of men over age 40 will suffer some degree of ED. This erectile dysfunction has substantial impact on interaction with their partners, families, and employment. ED may be a harbinger of more serious vascular events and is commonly associated with depression.

METHODS: Evaluation of ED begins with a careful history, asking the patient about his sexual function during clinical visits. Once identified, ED must be carefully considered with full history, careful physical examination, and laboratory studies to include markers of vascular risk factors, diabetes, and hypogonadism.

RESULTS: The treatment of ED was revolutionized by the introduction of phosphodiesterase type 5 (PDE5) inhibitors in 1998. Currently, 3 PDE5 inhibitors are available internationally with excellent expected results and somewhat unique profiles. Although these agents are safe in all patients who do not have severe cardiac disease or who are taking nitrate medications, they require some patient instruction and counseling to optimize results. In that small group of patients who do not respond to these oral medications, additional alternatives are available for patients motivated to pursue treatment of their ED.

CONCLUSION: Currently available safe and effective alternatives for the treatment of ED can improve the lives of patients and partners and increase their quality of life.

Key Words: erectile dysfunction, • sildenafil, • antidepressants.

Abbreviations: ED = erectile dysfunction;; NHSLS = National Health and Social Life Survey;; NANC = nonadrenergic-noncholinergic;; NO = neurotransmitters nitric oxide;; Ach = acetylcholine;; cGMP = cyclic guanosine monophosphate;; PDE5 = phosphodiesterase type 5.

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