Clinical management of erectile dysfunction

Erectile dysfunction (ED) affects 8% of 40-year-old men, increasing to 40% in 60-year-old men. It can be the first presentation of vascular disease and the average time between onset of ED and the first coronary vascular event is 3 years. The prevalence of ED is increasing and will continue to increase as the population ages. Prostate surgery commonly causes ED and nurses need to identify men with ED early, as treatment for ED should be commenced at the earliest opportunity provided the man and his partner want to engage in sexual activity. Options for treatment include phosphodiesterase type 5 inhibitors (sildenafil, tadalafil or vardenafil) as required, or ‘once daily’ for tadalafil. Alternative options include urethral pellets, intracavernosal injections, vacuum devices, counselling and penile prosthesis. The selection of treatment is dependent on an accurate assessment of the problem, an estimation of cardiovascular risk and of patient preference.