Erectile Dysfunction

ED Can be Managed in Primary Care

Men with erectile dysfunction, (ED), known also as impotence, don't need to undergo lots of evaluation or testing to identify a specific cause, they can simply be given a trial of a class of medications known as PDE5 inhibitors, the American College of Physicians has stated. That's according to a review of many studies published on the subject and analyzed by the college in this issue of Annals of Internal Medicine: Hormonal Testing and Pharmacologic Treatment of Erectile Dysfunction: A Clinical Practice Guideline From the American College of Physicians.

ED is already an extremely common condition and affects men of all ages. For many the condition is transient, but for those in whom it persists for longer than three months, the college states that some intervention is appropriate. Moreover, projections indicate that rates of ED are likely to increase dramatically as a result of aging and diseases like diabetes and cardiovascular compromise, so effective management is important.

PDE5 inhibitors include drugs like sildenafil, vardenafil, tadalafil, mirodenafil, and udenafil. They specifically inhibit an enzyme known as phosphodiesterase 5, and by inhibiting this enzyme, allow an erection to persist. The majority of men in whom these medications are tried respond well, with few side effects, although more than 10% report headache. Other fairly common side effects include dizziness, flushing, and upset stomach.

One of the most important aspects of the college's clinical guidelines is the recommendation that ED can be managed by primary care docs and doesn't usually require a special visit to a urologist. Additionally, measurement of blood levels of testosterone isn't helpful or necessary. Rick and I agree that this last is very important as testosterone levels are of increasing interest lately as the role of the hormone is scrutinized in everything from congestive heart failure to muscle preservation to osteoporosis, as is the potential utility for testosterone replacement therapy. Understanding where testosterone is and isn't a factor must underpin its use.

Other topics in this week's podcast include a new obesity drug reported on in the Lancet, fish oil and an antidepressant in people with both cardiovascular disease and depression in JAMA, and treatment of kids with kidney disease in NEJM. Until next week, y'all live well.

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9 Comments

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erectile difficulties March 5, 2011 at 2:03 am

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Darren May 13, 2010 at 11:50 am

Nice post about ED Can be Managed in Primary Care, in these days Erectile Dysfunction is more common and people have to try to be careful with their health for example I spend much money in buying generic viagra only because I need it.

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Sentry February 27, 2010 at 11:55 am

I notice that not so many websites address things like self confidence or substance use as a cause of erectile dysfunction. All too often it seems like there's a "real cause" besides something that reflects on the individual, and the conclusion is viagra or levitra.It is unavoidable though, that things like testosterone levels and injuries do play a large role in achieving an erection!

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Anonymous November 10, 2009 at 4:20 am

I also had a problem with impotence and was unable to perform. I discovered that anxiety and stress at work was my problem. I found a few herbal male impotence treatments online and they worked great. I don't take them as much anymore as exercise and a better diet has help me coup with the stress. It's good to know that I have something that can help during my time of need. Both of these products worked very well, but may not be for everyone. http://www.erectine.com and http://www.maxudishome.com

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