Initial Treatment of Erectile Dysfunction

Initial Treatment of Erectile Dysfunction

In all instances, medical conditions having an impact on erectile function should be corrected or their progression controlled.

However, treatment of these conditions does not guarantee the return of erectile function. Consideration should be given to discontinuation of any medication suspected of contributing to the erectile problem or, if required, switching to an alternative medication less likely to interfere with erectile function.

Patients and their partners should be educated about sexual issues and concerns. Discussing ways to enhance romance and caressing may help couples have more satisfying sex lives.

Patients with low testosterone and normal prolactin can be considered for testosterone replacement. Before the initiation of testosterone therapy, the patient should be evaluated for the possibility of an occult prostate malignancy, which may be stimulated by supplemental testosterone. Testosterone replacement may increase libido without improving erectile function.

Most patients with elevated prolactin levels can be managed medically, but some will require neurosurgical treatment.

Given the effectiveness of several treatment modalities (e.g., oral or intraurethral medication, vacuum constriction devices), it is reasonable to consider initiation of treatment for the remaining patients regardless of the erectile dysfunction etiology.

Patients with suspected vasculogenic or neurogenic causes can be considered for a trial of therapy in the primary care setting. Patients with a suspected psychogenic etiology should be considered for sexual counseling or psychiatric referral as well.

Patients requesting a more comprehensive evaluation or those not responding to initial therapy should be referred for further evaluation and treatment.