From the Guidelines
Assessment for Erectile Dysfunction (ED)
Erectile dysfunction (ED) assessment should start with a thorough medical history, including questions about the onset and duration of symptoms, as well as any underlying medical conditions or medications that may be contributing to the issue 1.
Key Components of Assessment
- A detailed history is most important, and for many patients, examination can be limited to blood pressure and examination of the genitalia 1.
- Patients should be informed about the advantages and disadvantages of each treatment and given advice on treatment outcome as well as ease of use 1.
- Lifestyle modifications, such as regular exercise, weight loss if needed, and quitting smoking, are recommended as initial steps.
Pharmacological Treatment
For pharmacological treatment, a phosphodiesterase type 5 inhibitor (PDE5i), such as sildenafil or tadalafil, can be considered as first-line therapy 1.
- Sildenafil can be taken at a dose of 50mg, 30 minutes to 1 hour before sexual activity, with a maximum dose of 100mg per day.
- Tadalafil can be taken at a dose of 10mg, 30 minutes to 1 hour before sexual activity, with a maximum dose of 20mg per day.
Alternative Options
If PDE5i is ineffective, other options like vacuum erection devices or intracavernosal injections with alprostadil may be explored.
- Alprostadil can be injected into the penis at a dose of 5-20mcg, 5-10 minutes before sexual activity.
Hormone Replacement Therapy
Hormone replacement therapy with testosterone may be considered if low testosterone levels are identified as a contributing factor.
- Testosterone can be injected intramuscularly at a dose of 50-100mg, every 2-4 weeks.
Ongoing Management
It is essential to monitor and adjust treatment as needed, and to address any underlying medical conditions that may be contributing to ED 1.
From the FDA Drug Label
Evaluation of erectile dysfunction and BPH should include an appropriate medical assessment to identify potential underlying causes, as well as treatment options. The assessment for Erectile Dysfunction (ED) includes:
- An appropriate medical assessment to identify potential underlying causes
- Evaluation of treatment options Key considerations in the assessment of ED include:
- Cardiovascular status: Physicians should consider the cardiovascular status of their patients, since there is a degree of cardiac risk associated with sexual activity 2. Note: The assessment tools used to evaluate the effect of tadalafil on erectile function include the Erectile Function (EF) domain of the International Index of Erectile Function (IIEF) and Questions 2 and 3 from Sexual Encounter Profile (SEP) 2.
From the Research
Assessment of Erectile Dysfunction (ED)
The assessment of ED involves a comprehensive evaluation of the patient's medical, sexual, and psychosocial history, as well as physical examinations and laboratory tests. The key aspects of assessment include:
- A detailed medical history, including a review of medical risk factors such as hypertension, diabetes, cardiovascular disease, and medications 3, 4, 5
- A detailed sexual history, including assessment of duration of ED, loss of libido, and overall sexual satisfaction 4, 6, 5
- A physical examination, including assessment of the cardiovascular, neurological, and urogenital systems 3, 4, 5
- Laboratory tests, such as fasting glucose and blood lipid profile, and free testosterone levels in men older than 50 years or if hypogonadism is suspected 3, 6, 5
- Use of validated questionnaires to provide an objective and systematic record of the patient's history 6
Evaluation Process
The evaluation process for ED typically involves:
- Identifying the underlying cause of ED, which can be classified into organic, psychogenic, or mixed 5
- Assessing erectile function in patients with risk factors for ED 5
- Conducting a thorough medical, sexual, and psychosocial history, including a review of medications used 3, 4, 5
- Performing physical examinations and laboratory tests to identify potential causes of ED 3, 4, 6, 5
Diagnostic Tests
Diagnostic tests for ED may include: