Overview: Managing Erectile Dysfunction
The full newsletter Managing Erectile Dysfunction, prescribing information and CME self-assessment are free for both AMA members and non-members.
Erectile dysfunction (ED) is defined as the consistent inability to attain or maintain penile erection of sufficient quality to permit satisfactory sexual intercourse. Its prevalence increases substantially with age, affecting 10-25% of middle aged and elderly men. Demographic changes, the popularity of newer treatments, and greater awareness of sexual dysfunction by patients and society have led to increased diagnosis and associated health care expenditures for the management of ED.
Conditions associated with ED include metabolic syndrome, lower urinary tract dysfunction secondary to benign prostatic hypertrophy, cardiovascular disease, diabetes mellitus and other endocrine disorders such as hypogonadism, and in some patients, central neurologic deficits (e.g. Parkinson’s disease) or prescription medicines. In particular, it is important to assess cardiovascular risk in patients who are candidates for pharmacologic therapy. The newsletter reviews existing algorithms for risk factor evaluation and management for patients with ED. Patients at low cardiovascular risk are generally deemed candidates for therapy while those at high risk are not. Patients at intermediate risk require assessment of their cardiovascular fitness to address whether they can safely exercise and engage in sexual intercourse.
With the advent of orally active, effective pharmacologic treatments, the potential exists for therapy to improve quality of life, self-esteem, and the ability to maintain intimate relationships. A good physician-patient relationship helps to unravel the possible causes of ED and standardized questionnaires are available to assess this disorder. Guidance is offered on the initial evaluation of ED, history and physical examination, and laboratory studies.
Despite the availability of highly effective medications, only about 25% of men diagnosed with ED are currently receiving pharmacological treatment. The full newsletter contains national patient claims data which are analyzed to show the patterns of use of oral medications including the prototypical phosphodiesterase type 5 inhibitors and androgen replacement therapy, as well as available injection therapies and transurethral delivery systems. Testosterone replacement is used to treat both primary and secondary causes of hypogonadism, but should not be used to treat ED without a documented diagnosis of hypogonadism. Four case studies are presented to help the learner better understand the various scenarios that typically confront the treating physician.
View the full newsletter Managing Erectile Dysfunction, and learn how to receive CME credit. Newsletters are available to all physicians, not just AMA members.