From the Guidelines
Erectile dysfunction (ED) is significantly influenced by risk factors such as age, cardiovascular conditions, diabetes, obesity, smoking, excessive alcohol consumption, and certain medications, as highlighted in the most recent guideline from the American Urological Association 1. The risk factors for ED can be broadly categorized into:
- Lifestyle factors: smoking, excessive alcohol consumption, and lack of physical activity
- Medical conditions: cardiovascular diseases, diabetes, obesity, and hypertension
- Psychological factors: stress, anxiety, depression, and relationship problems
- Medications: antihypertensives, antidepressants, and antiandrogens
- Hormonal imbalances: low testosterone levels
- Neurological conditions: nerve damage or disorders affecting nerve signals to the penis
- Pelvic surgeries or injuries: trauma or surgical complications affecting the penis or surrounding tissues
According to the European guidelines on cardiovascular disease prevention in clinical practice 1, ED is a marker for cardiovascular disease and a predictor of future events in middle-aged and older men. The American College of Physicians recommends that clinicians consider the individual preferences of men with ED, including ease of use, cost of medication, and adverse effects profile, when choosing a specific treatment 1.
The most effective approach to managing ED is to address the underlying risk factors, as stated in the guideline from the Journal of the National Comprehensive Cancer Network 1, which emphasizes the importance of lifestyle modification and treatment of psychosocial problems. Key considerations in the evaluation and management of ED include:
- Comprehensive medical, sexual, and psychosocial history
- Physical examination and selective laboratory testing
- Assessment of testosterone levels and consideration of hormonal therapy if indicated
- Referral to a mental health professional or sex therapist as needed
- Lifestyle modifications, such as smoking cessation, weight loss, and increased physical activity, to reduce the risk of ED and improve overall health.
From the FDA Drug Label
Tadalafil tablets are not right for everyone. Only your healthcare provider and you can decide if tadalafil tablets are right for you Before taking tadalafil tablets, tell your healthcare provider about all your medical problems, including if you: • have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. • have pulmonary hypertension • have low blood pressure or have high blood pressure that is not controlled • have had a stroke • have liver problems • have kidney problems or require dialysis • have retinitis pigmentosa, a rare genetic (runs in families) eye disease • have ever had severe vision loss, including a condition called NAION • have stomach ulcers • have a bleeding problem • have a deformed penis shape or Peyronie’s disease • have had an erection that lasted more than 4 hours • have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia
The risk factors for erectile dysfunction that are mentioned in the drug label include:
- Heart problems such as angina, heart failure, irregular heartbeats, or having had a heart attack 2
- Pulmonary hypertension
- Low blood pressure or uncontrolled high blood pressure
- Stroke
- Liver problems
- Kidney problems or requiring dialysis
- Retinitis pigmentosa
- Severe vision loss, including NAION
- Stomach ulcers
- Bleeding problems
- Deformed penis shape or Peyronie’s disease
- Prolonged erections
- Blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia It is essential to discuss these risk factors with a healthcare provider before taking tadalafil tablets.
From the Research
Risk Factors for Erectile Dysfunction
The following are some of the key risk factors for erectile dysfunction:
- Increasing age 3, 4, 5
- Depression 3, 5
- Obesity 3
- Lack of exercise 3
- Diabetes mellitus 3, 6, 4, 5, 7
- Hypertension 3, 4, 5, 7
- Dyslipidaemia 3
- Cardiovascular disease 3, 4
- Lower urinary tract symptoms related to benign prostatic hyperplasia 3
- Neurological conditions such as Parkinson's disease 4
- Pelvic surgery 4
- Endocrine disorders 4
- Interactions from prescribed drugs such as antihypertensives, antidepressants, antipsychotics, hormone treatments, and histamine H2 antagonists 4
- Anatomical features and anatomical conditions such as Peyronie's disease 4
- Lifestyle factors 5
- Anxiety 4
- Psychogenic components 6
Prevalence of Erectile Dysfunction
Erectile dysfunction is a common condition, affecting approximately 30 million men in the United States 5. The prevalence of erectile dysfunction varies depending on the population, age, and other factors, but it is estimated to affect between 32% and 90% of men with diabetes 6.
Relationship Between Erectile Dysfunction and Other Conditions
Erectile dysfunction is often associated with other conditions, such as coronary artery disease, hypertension, and diabetes mellitus 5. In fact, erectile dysfunction can be an indicator for undiagnosed diseases, highlighting the importance of early identification and treatment 5.