Men are increasingly seeking medical advice for the treatment of erectile dysfunction (ED) with the aim of improving their sex lives. However, few are aware that, in addition to being a debilitating health condition in its own right, ED is also an early indicator of other potentially life-threatening health conditions. ED presentations therefore offer health professionals an opportunity to identify and manage systemic health issues which often co-exist with ED but may go unidentified in the absence of a pro-active approach to screening ED presentations.1
Male patients have traditionally been much less likely to seek medical advice than their female counterparts, particularly for sexual health problems such as ED which they may be embarrassed to discuss with their doctor.2 Only 30% of Australian men discuss ED with a health professional, and of those, only 59% receive treatment for the condition.3 While ED is not a life-threatening condition, it adversely affects a man’s quality of life, psychological health and the health of his sexual relationship. It is therefore a legitimate health problem in its own right, requiring the best available treatment.4
Treating erectile dysfunction with PDE-5 inhibitors
Phosphodiesterase type 5 (PDE-5) inhibitors were developed for the treatment of ED and approved for use in Australia in the late 1990s.5 They have revolutionised and significantly improved ED treatment and its outcomes. In addition, the mass marketing of PDE-5 inhibitors direct to consumers has increased awareness of ED as a treatable health condition. As a result, more men are now consulting medical professionals about ED.1
This offers health professionals an opportunity to educate patients that, like all other health problems, sexual health problems are legitimate, have serious consequences and require treatment. It also enables health professionals to educate their patients about the effectiveness (or lack of effectiveness) of various treatment options. PDE-5 inhibitors have been demonstrated effective in the treatment of ED, and more than 50% of men have experienced improvements in erectile function while using the medication. On the other hand, alternative treatments that may be available over-the-counter in pharmacies or from alternative medicine practitioners have not been extensively tested and their safety profiles are largely unknown.6
Screening for systemic health issues in men with ED
In addition to enabling health professionals to educate patients about ED and its treatment options, the presentation of men with ED also presents opportunities for the early identification of systemic health issues.4 Although once thought to be almost entirely a psychological problem, ED is increasingly recognised as a vascular disorder mediated by endothelial function.7 Because the vessels that facilitate blood flow to and from the penis are smaller than other blood vessels in the body, they are thought to be affected by endothelial dysfunction much earlier than other vessels.4
Thus ED often occurs as the first clinically recognisable symptom of other conditions of vascular ill-health. For example, ED is an early indicator of and independent risk factor for cardiovascular disease. Men with ED are almost 1.5 times more likely to develop cardiovascular disease than men who do not experience ED. ED is also a common precursor for diabetes mellitus, and is the presenting complaint in more than 20% of men who are diagnosed with diabetes. It also often co-occurs with other vascular conditions, including hypertension and dyslipidaemia.1
Early identification and management of vascular conditions reduces morbidity, and can considerably improve a man’s overall health and reduce health costs. In addition, treating co-morbid vascular conditions optimises the outcomes of PDE-5 inhibitor therapy. Guidelines for managing patients presenting with ED are therefore increasingly recommending screening for other vascular conditions, including diabetes, hypertension and coronary artery disease, in patients who present with unexplained ED.4,6
Lifestyle modification to improve vascular health and erectile function
Many of the vascular conditions associated with ED arise from unhealthy behaviours such as smoking, poor nutrition or lack of exercise. Improving these lifestyle factors reduces the risk of systemic health conditions and also reduces a man’s risk of experiencing ED. For example, exercising7 and maintaining a Mediterranean-style diet9,10 have been shown to reduce the risk of ED, while being obese increases the risk of ED,8 even in individuals who subsequently lose weight.11
Providing advice to ED patients about lifestyle modifications which may improve their sexual function (and overall health) is therefore an important component of treatment (particularly because the threat of immediate sexual difficulties may provide some men with greater impetus to modify their lifestyle than the potential risk of future ill-health12).
ED is an important health issue in its own right. The availability of PDE-5 inhibitors has raised awareness of and increased the numbers of men presenting to health professionals with this complaint. It has also increased recognition that the condition is typically underpinned by endothelial dysfunction and associated with other vascular health conditions.7
ED presentations therefore provide a unique opportunity for pro-active health professionals to improve (and potentially save) their patients’ lives, by treating the underlying causes of ED and the lifestyle factors from which they arise. While PDE-5 inhibitors should not be withheld from patients who fail to modify their lifestyle, all patients with ED should be encouraged to modify aspects of their lifestyle which may affect not only their erections, but also their broader health and well-being. Such treatment is highly likely to improve a patient’s erectile function and sex life. It may also be an important aspect of preventing life-threatening conditions from arising in the future,4 and effectively treating ED may therefore help save a patient’s life.
- Nehra A. Erectile dysfunction and cardiovascular disease: Efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc. 2009;84(2):139-48.
- Holzapfel S. The physician’s role in dealing with men’s sexual health concerns. Can J Hum Sex. 1998;7(3):273-86.
- Kirby CN, Piterman L, Giles C. GP management of erectile dysfunction: The impact of clinical audit and guidelines. Aust Fam Physician. 2009;38(8):637-41.
- Hackett G, Dean J, Kell P. British Society for Sexual Medicine: Guidelines on the management of erectile dysfunction [online]. British Society for Sexual Medicine; 2007 [cited 25 February 2010]. Available from URL: http://www.bssm.org.uk/ downloads/ BSSM_ED_Management_Guidelines_2007.pdf
- Lowy M. Disorders of male sexual function. O&G Magazine. 2006;8(3):30-1 [cited 25 February 2010]. Available from URL: http://www.ranzcog.edu.au/ publications/ o-g_pdfs/ OG-Spring-2006/ Michael Lowy – Disorders of Male Sexual Function.pdf
- American Urological Association. Guideline on the management of erectile dysfunction: Diagnosis and treatment recommendations [online]. 2006 [cited 25 February 2010]. Available from URL: http://www.auanet.org/ content/ guidelines-and-quality-care/ clinical-guidelines.cfm?sub=ed
- Whittaker C. Phosphodiesterase type 5 inhibitors and erectile dysfunction. S Afr Pharm J. 2009;76(5):24-6.
- Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol. 2006;176(1):217-21.
- Giugliano D, Giugliano F, Esposito K. Sexual dysfunction and the Mediterranean diet. Public Health Nutr. 2006;9(8A):1118-20.
- Hannan JL, Maio MT, Komolova M, Adams MA. Beneficial impact of exercise and obesity interventions on erectile function and its risk factors. J Sex Med. 2009;6(Suppl 3):254-61.
- Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk? Urology. 2000;56(2):302-6.
- Gades NM, Nehra A, Jacobson DJ, McGree ME, Girman CJ, Rhodes T, et al. Association between smoking and erectile dysfunction: A population-based study. Am J Epidemiol. 2005;161(4):346-51.