Anger

• Marital problems

• Low self-confidence or morale

• Full inability to achieve erections

• Ability to achieve partial erections, but not suitable for intercourse

• Erections sufficient for intercourse, but early detumescence

• The problem may have a slow or acute onset, or may wax and wane Diagnosis

ED may be the presenting symptom of other chronic disease states.

Full medical, social, and medication histories should be taken to determine areas that can cause or exacerbate ED and to assess the patient's ability to safely perform intercourse.

• Medical history with emphasis on cardiovascular and psychiatric disorders, diabetes, trauma, and surgical procedures

• Social history: smoking, recreational drug use, exercise, and alcohol consumption

• Medication history including prescription, nonprescription, and dietary supplements PE

• Review for hypogonadism (gynecomastia, testicular atrophy, reduced body hair, increase in body fat)

• Digital rectal exam to determine if prostate is enlarged

• Abnormalities of the penis or impaired vasculature and nerve function to the penis Labs

• Thyroid function Fasting lipid panel

• HbA1c Metabolic panel

• Serum testosterone Further cardiac testing if warranted Determine severity

• Sexual health inventory for men :

• How do you rate your confidence that you could get and keep an erection?

• When you had erections with sexual stimulation, how often were your erections hard enough for penetration?

• During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

• During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

• When you attempted sexual intercourse, how often was it satisfactory for you?

• Questions scored 1 to 5, very low to very high respectively. Score of 21 or less indicates ED likely.

Table 51-3 Common Drug Treatment Regimens for ED

Rouit el AdnHnlilfitlan

G»n»rk

Manse

Brand Name

SlkfenaH

Vijyu

TWalafl

Oafc

Van depart

imtn

Ifohimblne*

Aphrodyne, Ifocon

AlfJOiUiii

C^Mtrjeti, cavefiott

Impulse, Edcx

Papatfttlne

N/A

ItitntoLmilne

M/A

flipKHra*!

MUSf

leiwiieicme

C?ep3-ïeiiûiien5iie

Typlta I Dosing flange*

Typlta I Dosing flange*

Maximum Dating frequency

i'lh.jf .jkH.irKruVI

I nil i unfl JI unarouKular topical

ButuL

iutxuwnecus Implantable pellet feiKMieione enanthate IftTOH ClOne fwich«

restoneionegci fOiToU ClOnC

[WJieiuyl itticdcim Tttlùdfrffi Tis AndriXtrm ArvlroGe) i^iim autant ittlCtK-1

35-lQOrny I itour prk* loimerrajrHi b-Ji> mc) prior to Intercourse

JnJJ rnif 1 hour piiw 10 nmcftourtt mg i rimes daily US-60 meg 5-30 rTilnut« ptiof (0

Intern:'HiisC nyptf.illy ijxvI iit fombiriiiKYi ,14

vai table doses Typically <jsed in fQmhinjiijn .11 vai ¡able doses

IJ5-1JJ00 meg 4-10 irunuitt prior to intercourse' 50 *30 n*) evei y 2 4 werti

50 <100 ring every 2-

upper hutiocks 3.5- 5 rtl^rtJdy JppSetJ 10 tHCfc.

aOdomea upper itmior (highs 5- log atjilylOihOeUTHS. upCir 01 ahf kynen (ArvlioOel only) 30 my every 13 hours CO gum region above incisor; waw to jiierrisie side;

with each dose 150-450 tinq <150 mg feK every 35 m^ testosterone propionate required weeWy)

Onu? daily

Once daily

Once daily

J Hmoi weekly. 34 hcdij between h^cctlore

1 ilmetwwkly, hc*ns between ¡Trottions

3 llmeSi wwkly, /I hocjis between dejections

2 llrn« dally

Onceiveeiiy

Once i*>MHy OfKCdJity OnCt* daily Oncedaay Once daily Twice tUHy

EvCfyilO frir'KifH hi

MlfiE, midfcaliduicthraJsyaerri ta crwtJi ■Uieiheiomst effectue do« 10 limit efleas. ■Hijl rOA-ie* lhr. ifylir^iLy-i Initial tase nursr he nv.iied n pHysicLiiïi of lice.

A wide range of treatment options is now available for men with ED. These include medical devices, pharmacologic treatments, lifestyle modifications, surgery, and psychotherapy.

When determining the best treatment for an individual, the role of the clinician is to inform the patient and his partner of all available options while understanding his medical history, desires, and goals. Most often treatment is initiated with the least invasive option and then treatment progresses to more invasive options if needed. Ultimately, the choice of therapy should be individualized, taking into account patient and partner preferences, concomitant disease states, response, administration route, cost, tolerability, and safety. Common drug treatment regimens for ED are listed in Table 51-3.

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