What is the approach to managing erectile dysfunction (ED)?

From the Guidelines

Erectile dysfunction (ED) should be approached through a comprehensive evaluation and management plan that includes lifestyle modifications, medical interventions, and psychological counseling, as recommended by the American Urological Association (AUA) guideline 1.

Key Components of ED Management

• A thorough medical, sexual, and psychosocial history, physical examination, and selective laboratory testing should be performed to identify underlying causes of ED.
• Validated questionnaires, such as the Erection Hardness Score and the Sexual Health Inventory for Men, can be used to assess the severity of ED and guide treatment.
• Lifestyle modifications, including reducing alcohol consumption, quitting smoking, exercising regularly, maintaining a healthy weight, and managing stress, are essential for improving ED symptoms.
• First-line treatments for ED include oral medications like sildenafil (Viagra, 25-100mg), tadalafil (Cialis, 5-20mg), vardenafil (Levitra, 5-20mg), or avanafil (Stendra, 50-200mg), taken 30-60 minutes before sexual activity, as recommended by the NCCN Survivorship Panel 1.

Special Considerations

• Men with ED should be counseled about the potential risk of underlying cardiovascular disease and other health conditions that may warrant evaluation and treatment.
• Morning serum total testosterone levels should be measured in all men with ED to determine if testosterone deficiency is present, as recommended by the AUA guideline 1.
• Referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship, as recommended by the AUA guideline 1.

Alternative Treatments

• For men who do not respond to oral medications, alternatives include vacuum erection devices, penile injections (alprostadil), urethral suppositories, testosterone replacement (if levels are low), or penile implants, as discussed in the NCCN Survivorship Panel guidelines 1.
• Psychological counseling may help address anxiety, depression, or relationship issues contributing to ED, and can be used in conjunction with medical therapy, as recommended by the NCCN Survivorship Panel 1.

From the FDA Drug Label

Tadalafil tablets are a prescription medicine taken by mouth for the treatment of: men with erectile dysfunction (ED) Tadalafil tablets helps increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.

The approach to managing erectile dysfunction (ED) involves taking tadalafil tablets, which help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. It is essential for men with ED to consult their healthcare provider for help if the condition bothers them. Tadalafil tablets are not a cure for ED, and they do not increase a man's sexual desire or protect against sexually transmitted diseases.

• Key points:
  • Tadalafil tablets are for men over 18 years old.
  • Men with ED should see their healthcare provider for help.
  • Tadalafil tablets help increase blood flow to the penis.
  • The tablets do not cure ED or increase sexual desire.
  • They do not protect against sexually transmitted diseases.

2

From the Research

Approach to Managing Erectile Dysfunction (ED)

The approach to managing ED involves a combination of lifestyle modifications, medical treatments, and counseling.

• Lifestyle modifications include:
  • Tobacco cessation 3, 4, 5
  • Regular exercise 3, 4, 5
  • Weight loss 3, 4, 5
  • Improved control of diabetes, hypertension, and hyperlipidemia 3, 6, 5
• Medical treatments include:
  • Oral phosphodiesterase-5 inhibitors as the first-line treatment 3, 6, 7
  • Alprostadil and vacuum devices as second-line treatments 3, 6
  • Surgically implanted penile prostheses as an option when other treatments have been ineffective 3, 6
• Counseling is recommended for men with psychogenic ED 3

Evaluation and Diagnosis

The evaluation of men with ED requires a full medical and personally and culturally sensitive sexual history, a focused clinical examination, fasting glucose levels, a fasting lipid profile, and, in select cases, a total testosterone level and a prostate-specific antigen test 6

Treatment Outcomes

Between 60% and 65% of men with ED can successfully complete intercourse in response to phosphodiesterase type 5 inhibitors (PDE5i) 6 Patient-administered intracorporal injection therapy using vasodilator drugs such as alprostadil is an effective treatment and is useful in men who fail to respond to oral pharmacological agents 6, 7 Surgical treatment of ED with multicomponent inflatable penile implants is associated with high satisfaction rates 6