MRCGP exam update: Treatment of erectile dysfunction

Current situation

  • Erectile dysfunction (ED) is very common. In the UK, one in 10 men will suffer from ED at some stage in their lives.
  • Although the introduction of oral medication for ED raised its profile, only about half those affected report their symptoms of ED to their GP.
  • Smoking and alcohol are important risk factors.

What is the evidence?

  • Oral phosphodiesterase-5 (PDE-5) inhibitors have become the treatment of choice for most patients as they are more convenient than injections or vacuum devices.
  • About 80 per cent of men report improved erections with PDE-5 inhibitors in a randomised controlled trial (J Urol 2002; 168: 1,332).
  • Healthy older men who develop ED could be harbouring occult cardiovascular disease (CVD), according to a recent study (JAMA 2005; 294: 2,996). ED was shown to be an independent risk factor for CVD of similar magnitude to family history or smoking.
  • However, improved cardiovascular risk factor control is likely to increase the efficacy of PDE-5 inhibitor therapy in the treatment of ED (Am J Hypertens 2006; 19: 915).
  • In men with ED from five nations, sildenafil produced substantial improvements in self-esteem, confidence and sexual relationship satisfaction, in addition to improvements with erectile function (J Gen Intern Med 2006; 21: 1,069).
  • Some dietary supplements marketed for the treatment of ED have actually been shown to contain PDE-5 inhibitors (J Urol 2005; 174: 636). This is concerning because many of these products claim to be free of adverse effects but may be fatal to patients concomitantly using nitrates.
  • One study found that most clinicians and patients preferred tadalafil over sildenafil (BJU Int 2006; 98: 623).

Implication for practice

  • Virtually all patients now choose oral medication as first-line treatment for ED.
  • Tadalafil has a much longer duration of action than the other drugs. In addition, its absorption is unaffected by fatty foods.
  • Fasting glucose is an important investigation. A recent study found men under the age of 45 years with ED had an increased risk of diabetes — in those between 26 and 35 years,
  • ED nearly tripled the odds of having diabetes (J Urol 2006; 176: 1,081).

Available guidelines

European Association of Urology Guidelines on Erectile Dysfunction, March 2006 (PDF link)

Useful websites

www.library.nhs.uk National Library for Health

www.nice.org.uk NICE


Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for MRCGP and General Practitioners’, Pas Test 2006

Key points

  • ED is still underdiagnosed.
  • PDE-5 inhibitors are the mainstay of treatment.
  • Young men with ED have increased risk of diabetes.
  • Healthy older men who develop ED could be harbouring occult CVD.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

The original Moderna COVID-19 vaccine

First COVID-19 vaccine to target Omicron variant approved for use in UK

The MHRA has approved an updated version of the Moderna vaccine that targets both...

Ballot box

Majority of GPs back taking industrial action in the coming year, poll suggests

The majority of GPs support taking industrial action in the coming 12 months to push...

RCGP sign

NHS winter plan does not provide enough support for GPs, warns RCGP

NHS England's winter plan does not include enough measures to support general practice...

NHS sign

Plans to recruit 1,000 new link workers to support GP practices this winter

NHS England has set out plans to recruit an additional 1,000 social prescribing link...

BMA House

BMA prepares to ballot junior doctors on industrial action

Junior doctors will be balloted over industrial action if the government does not...

Typing on a laptop

NHS 111 systems could be offline until next week following cyber attack

NHS 111 systems could be offline until next week following the cyber attack on a...