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Male Sexual Dysfunction: Treatment Patient Education Patient and partner education is essential in the treatment of ED. In goaldirected therapy, education facilitates understanding of the disease, results of the tests, and selection of treatment. Discussion of treatment options helps to clarify how treatment is best offered and stratify first- and second-line therapies. Patients with high-risk lifestyle issues, such as smoking, alcohol abuse, or recreational drug use, should be counseled on the role these factors play in the development of ED. Oral Agents Sildenafil, tadalafil, and vardenifil are the only approved and effective oral agents for the treatment of ED. . | Chapter 049. Sexual Dysfunction Part 5 Male Sexual Dysfunction Treatment Patient Education Patient and partner education is essential in the treatment of ED. In goal-directed therapy education facilitates understanding of the disease results of the tests and selection of treatment. Discussion of treatment options helps to clarify how treatment is best offered and stratify first- and second-line therapies. Patients with high-risk lifestyle issues such as smoking alcohol abuse or recreational drug use should be counseled on the role these factors play in the development of ED. Oral Agents Sildenafil tadalafil and vardenifil are the only approved and effective oral agents for the treatment of ED. These three medications have markedly improved the management of ED because they are effective for the treatment of a broad range of causes including psychogenic diabetic vasculogenic postradical prostatectomy nerve-sparing procedures and spinal cord injury. They belong to a class of medications that are selective and potent inhibitors of PDE-5 the predominant phosphodiesterase isoform found in the penis. They are administered in graduated doses and enhance erections after sexual stimulation. The onset of action is approximately 60-120 min depending on the medication used and other factors such as recent food intake. Reduced initial doses should be considered for patients who are elderly taking concomitant alpha blockers have renal insufficiency or are taking medications that inhibit the CYP3A4 metabolic pathway in the liver e.g. erythromycin cimetidine ketoconazole and possibly itraconazole and mibefradil as they may increase the serum concentration of the PDE-5 inhibitors or promote hypotension. Testosterone supplementation combined with a PDE-5 inhibitor may be beneficial in improving erectile function in hypogonadal men with erectile dysfunction who are unresponsive to PDE-5 inhibitors alone. These drugs do not affect ejaculation orgasm or sexual drive. Side effects .
