Erectile DysfunctionDr P A Nathan

Hollybrook Medical Centre

How common?50% of men between 40-70yrs

70% of men aged 70yrs

HistoryKey Points

Difficulty getting and maintaining erectionPremature ejaculationPsychosocial

CausesIHD ,hypertension, High cholesterol DiabetesNeurological problemsLow testosterone – previous head injury Nerve damage – pelvisDrugsAlcohol CyclingPsychological or mental health

Risk factorsSmokingHigh blood pressureWeightInactivity Diet AlcoholDiabetes

InvestigationsBloodsMSUBpECG

PrescribingWhen was viagra available?What classification of drug?Which neurotransmitter is involved?What contra-indications are there to oral

medication?What is important about alpha-blockers?How successful is this treatment?Who is at risk of prolonged erections?How is prescription endorsed?

What is significant about this date?

1 July 1999

NHS criteria Diabetes, MS , Parkinson’s diseasePoliomyelitis, prostate cancer , severe pelvic

injury, single gene neurological disease, spina bifida, spinal cord injury

Dialysis for renal failureRadical pelvic surgery, prostatectomy, renal

transplantWere receiving other treatments on

14.9.1998Suffering severe stress (specialist centre)

Severe stressSignificant disruption to normal social and

occupational activitiesMarked effect on mood, behaviour , social

and environmental awarenessMarked effect on interpersonal relationships

Side effectsDyspepsia, VomitingHeadachesFlushingDizziness, myalgia, visual disturbancesRaised intra-ocular pressureNasal congestion hypersensitivity reasctionsPriapism, Painful red eyes

More prescribingWhich agent?How many?Where can I get it from? Interactions

Comparison Sildenafil Tadalafil vardenafil

Time for onset 15 mins 30 mins 60 mins

Duration 5 hrs 36 hrs 4 hrs

Dose Range 25-100mg 10-20 mg 5-20 mg

Main side effects

Headache, flushing

Muscle, back, stomach pain

Hypotension, MI, Stroke

Dose frequency 24 hrs 24 hrs (not recommended)

24 hrs

Cost £2.34-7.25 £5.85-6.45 £2.87-7.63

Brand name Viagra Cialis Levitra

Daily dose 2.5-5mg

What is the cost of nhs prescription?

£7.85

What other agents can you use?Apomorphine (uprima)Alprostadil

CaverjectVirdal duoMUSE

Herbal alternatives?What herbal treatments are available for

treating erectile dysfunction?Yohimbe – African tree bark Chinese horny goat weedGinko BilobaRed ginseng (natural source of sildenafil)

Other treatmentsTreat underlying conditionPsychosexual counselling

When to refer?Vaccum devicesPenile prosthesis

Any Questions?