Accordingly, patients with ED can be stratified into three cardiovascular risk categories Table 2, which can be used as the basis for a treatment algorithm for initiating or resuming sexual activity Figure 2. In particular, it should be explained that sexual stimulation is necessary and that more than one trial with the medication may be required to establish efficacy. For other special populations i. As part of the process of identifying the optimal dose, men may be offered dosing frequency changes or different PDE5i. Patients should be counseled regarding risks, benefits, and expectations of this procedure.
Erectile dysfunction ED is the preferred clinical term describing the persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months. PCPs, urologists, internists, psychiatrists, and other treating healthcare professionals should be encouraged to initiate an open dialogue of sexual issues to identify men with ED who may not otherwise volunteer their sexual concerns. Frequently a careful history, physical exam, serum glucose or hemoglobin A1C, lipid profile and optional hormonal testing facilitate the diagnosis of ED and effective therapy. Organic physical causes of ED are present in most men, but situational or psychosocial contributing factors often play a contributory role. Addressing these issues may enhance treatment efficacy. Underlying risk factors associated with ED are common to cardiovascular disease in general, and should be identified during evaluation as they may represent the initial clinical sign of generalized endothelial disease vascular insufficiency. Evaluation of family history, nicotine use, blood pressure, lipid profile, and glucose is required or should be documented if previously performed. Active management of identified cardiac risk factors should be instituted i.
Mean IIEF-5 score improved from Consider more frequent dosing regimes. Enact lifestyle changes and risk factor modification prior to or accompanying erectile dysfunction ED treatment. It is also essential to assess patient satisfaction since successful treatment for ED goes beyond efficacy and safety. Only two questionnaires can discriminate between patients who have PE and those who do not.