Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. ED can affect the physical, emotional, and psychosocial health of the affected man and his partner. ED is an independent risk factor for cardiovascular disease (CVD), stroke and all-cause mortality. This article provides a best practice approach to the management of ED in primary care. The key messages of the article are depicted in two summary flowcharts to support clinical decision-making. Any treatment must satisfy the dual goals of managing the ED symptom and assessing and appropriately managing the heightened CVD risk.
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References
1.
AllenMSWalterEE (2019) Erectile dysfunction: An umbrella review of meta-analyses of risk-factors, treatment, and prevalence outcomes. The Journal of Sexual Medicine16(4): 531–541. DOI: 10.1016/j.jsxm.2019.01.314.
FeldmanHAGoldsteinIHatzichristouDG, et al.(1994) Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. The Journal of Urology151(1): 54–61. DOI: 10.1016/s0022-5347(17)34871-1.
6.
FodeMSaloniaAMinhasS, et al.(2019) Late-onset hypogonadism and testosterone therapy - A summary of guidelines from the American Urological Association and the European Association of Urology. European Urology Focus5(4): 539–544. DOI: 10.1016/j.euf.2019.02.021.
7.
GandagliaGBrigantiAJacksonG, et al.(2014) A systematic review of the association between erectile dysfunction and cardiovascular disease. European Urology65(5): 968–978. DOI: 10.1016/j.eururo.2013.08.023.
8.
HackettGKirbyMRamachandranS (2020) Erectile dysfunction: Is the NHS men’s health friendly?Trends in Urology & Men’s Health11(5): 6–12. DOI: 10.1002/tre.765.
9.
HackettGKirbyMWylieK, et al.(2018) British Society for Sexual Medicine guidelines on the management of erectile dysfunction in men-2017. The Journal of Sexual Medicine15(4): 430–457. DOI: 10.1016/j.jsxm.2018.01.023.
10.
Hippisley-Cox J, Coupland C and Brindle P (2017) Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: Prospective cohort study. BMJ (Clinical Research ed.) 357: j2099. DOI: 10.1136/bmj.j2099.
11.
KatsikiNWierzbickiASMikhailidisDP (2015) Erectile dysfunction and coronary heart disease. Current Opinion in Cardiology30(4): 416–421. DOI: 10.1097/HCO.0000000000000174.
12.
Melnik T, Soares BGO and Nasselo AG (2007) Psychosocial interventions for erectile dysfunction. The Cochrane Database of Systematic Reviews 3: art. no.: CD004825. DOI: 10.1002/14651858.CD004825.pub2.
13.
MulhallJPTrostLWBranniganRE, et al.(2018) Evaluation and management of testosterone deficiency: AUA guideline. The Journal of Urology200(2): 423–432. DOI: 10.1016/j.juro.2018.03.115.
14.
NehraAJacksonGMinerM, et al.(2012) The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clinic Proceedings87(8): 766–778. DOI: 10.1016/j.mayocp.2012.06.015.
15.
NguyenHMTGabrielsonATHellstromWJG (2017) Erectile dysfunction in young men-A review of the prevalence and risk factors. Sexual Medicine Reviews5(4): 508–520. DOI: 10.1016/j.sxmr.2017.05.004.
NHS Business Services Authority (2021b) Part XVIIIB. Drugs, medicines and other substances that may be ordered only in certain circumstances. Available at: www.drugtariff.nhsbsa.nhs.uk/#/00320999-DC_1/DC00320463/In England: (accessed 15 January 2021).
