From the Guidelines
Erectile dysfunction can be effectively treated with lifestyle modifications and medications, with phosphodiesterase type 5 (PDE5) inhibitors being a first-line treatment option.
Treatment Options
The treatment of erectile dysfunction (ED) begins with the identification of organic comorbidities and psychosexual dysfunctions, and both should be appropriately treated or their care triaged 1.
- Lifestyle modifications, such as regular exercise, weight management, and reducing alcohol and tobacco use, can help alleviate symptoms of ED 1.
- Medications such as PDE5 inhibitors, including sildenafil (Viagra, 25-100mg taken 30-60 minutes before sexual activity), tadalafil (Cialis, 5-20mg as needed or 2.5-5mg daily), vardenafil (Levitra, 5-20mg), or avanafil (Stendra, 50-200mg), are typically first-line treatments 1.
Important Considerations
These medications work by increasing blood flow to the penis by relaxing smooth muscles and blood vessels, but require sexual stimulation to be effective 1.
- They shouldn't be used by men taking nitrates or with certain cardiovascular conditions 1.
- Alternative treatments include vacuum erection devices, penile injections (alprostadil), urethral suppositories, testosterone replacement if deficient, or penile implants for severe cases 1.
- Psychological counseling may help when ED has emotional causes 1. It's essential to consult a healthcare provider before starting any treatment, as ED can sometimes indicate underlying health issues like heart disease, diabetes, or hormonal problems that may require additional management 1.
From the FDA Drug Label
5 WARNINGS AND PRECAUTIONS Evaluation of erectile dysfunction (ED) should include an appropriate medical assessment to identify potential underlying causes, as well as treatment options.
The evaluation of erectile dysfunction (ED) should include an appropriate medical assessment to identify potential underlying causes, as well as treatment options.
- Medical assessment is necessary to identify potential underlying causes of ED.
- Treatment options should be considered based on the underlying causes of ED. According to the FDA drug label of avanafil 2, the treatment of ED should be approached with caution, considering the potential underlying causes and the patient's overall health status.
From the Research
Causes and Risk Factors of Erectile Dysfunction
- Erectile dysfunction (ED) is a common medical disorder whose prevalence is increasing worldwide 3
- Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption 3, 4
- These metabolic conditions are strongly associated with a pro-inflammatory state that results in endothelial dysfunction by decreasing the availability of nitric oxide (NO), which is the driving force of the blood genital flow 3
Lifestyle Modifications and Erectile Dysfunction
- Lifestyle and nutrition have been recognized as central factors influencing both vascular NO production, testosterone levels, and erectile function 3
- Lifestyle modifications such as smoking cessation, weight reduction, dietary modification, physical activity, and psychological stress reduction have been increasingly recognized as foundational to the prevention and treatment of ED 4
- Clinical trials have shown that lifestyle modifications were effective in ameliorating ED or restoring absent ED in people with obesity or metabolic syndrome 3
Treatment Options for Erectile Dysfunction
- Phosphodiesterase type 5 (PDE5) inhibitors are currently the first-line treatment option for ED 5, 6
- PDE5 inhibitors such as sildenafil, tadalafil, and vardenafil are the most widely used and studied 6
- Avanafil is a new oral PDE5 inhibitor that has been investigated for the treatment of ED, with enhanced selectivity, faster onset of action, and a favorable side-effect profile 5
- A systematic review and network meta-analysis has shown that tadalafil seems to be the most effective agent, followed by vardenafil, with no major difference in safety profile among different agents 7