Erectile dysfunction
History
All patients with cardiovascular disease and diabetes should be asked about ED. What is the Problem?...erections, sex drive, ejaculation, peyronies
If ED is it Psychogenic or Organic?...ask about waking erections. If present and good quality, problem is psychogenic. If as poor as during sexual activity problem is likely to be organic.
Check re partner's attitude re treatment.
Psychogenic ED
try treating with Sildenafil 50 mg orally at least 1 hour before or Apomorphine 3mg sublingually 20 mins before sex for 3-4 months to break the cycle of failure and performance anxiety. If still a problem refer to a sex therapist.
Organic ED
Examine genitalia for signs of hypogonadism and penile abnormality and check BP.
Investigations
- blood glucose, lipids.
- Check testosterone, LH, FSH and prolactin only if sex drive reduced
Treatment
Initial treatment of choice is Sildenafil 50 mg or 100 mg if ineffective. Emphasise will only work if sexual stimulation present and should try on 6-8 occasions before abandoning. Apomorphine is unlikely to work in these men.
Impotence treatment
GP's can prescribe impotence treatments for men on the NHS, i.e. those who have:
- radical pelvic surgery
- prostate removed and/or
- treatment cancer prostate
- renal failure (transplant & dialysis )
- spinal cord & severe pelvic injury
- diabetes
- multiple sclerosis
- single gene neurological disease
- poliomyelitis
- spina bifida
- parkinson's disease
- severe distress after specialist services assessment only
In addition, patients who were receiving impotence treatment on 14 September 1998 also eligible for NHS prescriptions
- No more than ONE treatment per week, normally
- Men not in the above category may receive private prescription from their own GP
Drugs affected by this regulation (1stJuly 1999)
- Sildenafil
- Alprostadil
- Caverject
- MUSE
- Erecnos
- Viridal
Treatment choice for erectile dysfunction
| Step 1 |
Stabilise general clinical condition
BP <160/90 HbA1c normal |
| Step 2 | Treat any medical condition |
| Step 3 |
Initiate specific therapy
|
Key precautions
- Contraindicated in
- unstable diabetes
- recovery M.I.
- stroke
- Caution in penile abnormalities
- no alprostadil in Peyronies
- leukaemia, myeloma, sickle cell disease
- Sildenafil (Viagra) never with any form NITRATES