- Incidence of ED is approximately proportional to age, ie. 60% of 60y olds, with half that number severely affected. ED aetiology is usually a combination of organic and psychological causes.
- ED itself is a cardiovascular risk factor conferring a risk equivalent to a current moderate level of smoking (HR 1.46)
- The pro-active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors
- Mainstay of contemporary treatment is with PDE5i that can be instigated in primary care.
- Medical & psychosexual hx. Examination to include penile deformity?, BP and gross neuro exam, peripheral vascular exam.
Baseline tests: fasting glucose, lipids, Free Androgen Index (test profile- testosterone, SHBG & Free Androgen index) between 9-11am.” “If Free Androgen Index is low or borderline then repeat it (between 9am-11am) and also test for FSH, LH and Prolactin. If considering testosterone replacement then also test PSA.
Management prior to referral:
- Modifiable lifestyle changes
- Consider changing drugs associated with ED
- Psychosexual counselling where relevant (RELATE)
- Beware CI, concomitant nitrate use
- All PDE5i similar efficacy overall, individual responses vary
- Try Viagra & Cialis & Levitra at maximum dose x8 each drug taken 1-2x/week before declaring failure
- Where PDEi successful subsequently titrate down dose
Who to refer: (Mr Willis does not see ED referrals)
- PDE5 failures and CIs only
- Those with penile deformity (ask patient to bring photos of errect penis to OPA)
- For those with ED and hypogonadism (Testosterone below normal range) refer to endocrine dept. for consideration of supplementation
- Caverject/Muse therapy undertaken in Urology OPA in the absence of a specialist ED clinic currently.
- Insertion of penile prosthesis is not routinely commissioned by NHS Kernow
- Vacuum pumps can be purchased from reputable medial suppliers, see www.sexualadviceassociation.co.uk/pump