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Education and Counseling for Erectile Dysfunction

Education and counseling is an important aspect of the management of erectile dysfunction (ED) and should involve both the patient and their partner. Ideally, education and counseling should occur prior to starting any type of medical therapy for ED and should focus on the following areas:

• Answering any questions the patient and their partner have about ED.
• Addressing any misconceptions the patient and their partner have about ED.
• Setting realistic expectations of ED treatments and outcomes.
• Anxiety management and cognitive behavioral therapy should be encouraged for all patients whose symptoms are determined to be primarily caused by underlying psychological factors (psychogenic ED).
• Sex counseling may be appropriate for many couples by helping them discuss and overcome issues that may interfere with sexual feelings and performance.

• Educating and counseling patients about lifesyle modifications that can improve sexual performance and also prevent ED from progressing:

  • smoking cessation
  • limiting alcohol consumption
  • avoiding use of recreational drugs
  • promoting exercise as a means of boosting energy levels and stamina

Drug Therapy for Erectile Dysfunction

Testosterone Replacement Therapy

Testosterone is a sex horomone produced by the testes that promotes the development of male sexual characterists (e.g., deep voice; beard) and also increases bone and muscle mass. Testosterone replacement therapy is a first-line treatment option for men with low testosterone levels and men with hypogonadism (inadequate function of the testes). In these cases, testosterone replacement therapy has been found to:

• Increase sexual interest
• Increase the number of nocturnal erections
• Increase the frequency of sexual intercourse

The goal of testosterone therapy is to raise the levels of testosterone back into the normal range (270 to 1,100 nanograms per deciliter). Testosterone may be administered by various routes including:

• Injection
• Skin patches
• Topical gels
• Oral tablets

Potential risks associated with long-term testosterone replacement therapy include:

• Liver cancer
• Hepatitis
• Jaundice
• Gynecomastia - abnormal enlargement of the male breasts
• High blood pressure
• Benign prostatic hyperplasia (BPH)
• Prostate cancer - Monitoring for prostate cancer by digital rectal examination and prostate specific antigen (PSA) screening is recommended for men undergoing testosterone replacement therapy.

Phosphodiesterase-5 Inhibitors

Phosphodiesterase-5 (PDE-5) inhibitors , which initially became available in 1998, are important first-line treatments that have revolutionized the treatment of erectile dysfunction (ED). Erections in men are mediated through a system called the nitric oxide signaling pathway. Nitric oxide is a substance that causes relaxation of the smooth muscles of the penis resulting in dilatation (widening) of the blood vessels of the corpus cavernosum and increased blood flow to the penis. An enzyme called cyclic guanosine monophosphate (CGM) plays an important role in regulating the nitric oxide signaling pathway. Another enzyme called PDE-5 , found primarily in the smooth muscle of the corpus cavernosum, breaks down the CGM enzyme, thereby, helping the erect penis return back to its normal flaccid form. Medications known as PDE-5 inhibitors prevent the breakdown of the CGM enzyme by PDE-5, thereby, enabling the nitric oxide signaling pathway to continue to exert its relaxation effect on the smooth muscles of the penis and promote increased blood flow that is necessary for achieving and maintaining an erection.