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Erectile dysfunction needs all-round care – Not just a Band-Aid solution

One in five Australian men over the age of 40 report having moderate or severe erectile dysfunction, with this figure rising to two-thirds of men over the age of 70.1

Erectile dysfunction (ED) is the persistent inability to get and/or maintain an erection sufficient for satisfactory sexual activity.

This condition can significantly impact the quality of life of Australian men, but only up to a third of men may seek medical help for their condition.1

Men with erectile problems can often be embarrassed, or have the view that if they are not sexually active, it is not a major concern.

However, erectile dysfunction is often associated with important medical problems and is frequently a secondary manifestation of a primary disorder.

The pathophysiology of erectile dysfunction is varied and may include vascular, neurological, anatomical, hormonal or drug-induced causes.2

ED and cardiovascular disease

In addition to sexual arousal, erections rely on an adequate blood flow to the penis and normal endothelial and nerve function.

As such, erectile dysfunction is more prevalent in men with, or at risk of, cardiovascular disease (CVD), including coronary heart disease.

Risk factors for erectile dysfunction and CVD are essentially the same and include diabetes, hypertension, high cholesterol, smoking, obesity and physical inactivity.2,3

ED and urinary symptoms

Lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH) are commonly associated with erectile dysfunction.4,5

LUTS and BPH impact considerably on a man’s quality of life; these conditions are consistently linked to sexual health conditions and poor mental health, including depression and anxiety.6,7

LUTS often co-exist with chronic medical conditions such as diabetes, obesity, hypertension or obstructive sleep apnoea, representing shared risk factors with erectile dysfunction and CVD.6,7

ED and chronic ill health

Depression and anxiety frequently co-occur with erectile dysfunction; this can be an underlying cause or a consequence of experiencing erectile dysfunction.8

A host of other burdensome pathologies have been linked to erectile dysfunction, including psoriasis, gout, inflammatory arthritis, non-alcoholic fatty liver and chronic liver disease, periodontal disease, glaucoma and inflammatory bowel disease.2

It is likely that chronic ill health impacts sexuality, including increasing the prevalence of erectile dysfunction.

ED treatments

Pharmacological agents for erectile dysfunction (PDE5 inhibitors) are usually the first-line treatment after modifiable risk factors and causes are addressed.

Some men may require sexual health counselling, with or without their partners being involved.

Vacuum devices or constriction rings may be appropriate for men in which pharmacology is contraindicated, particularly if the ED is mild.

Complex cases may necessitate urological referral and the adoption of treatments such penile injections (contraindicated in risk of priapism), or in rare cases, surgical interventions.

Erectile dysfunction rarely occurs in isolation. It is a warning sign or red flag for the presence of another potentially serious condition which should not be overlooked.

Erectile dysfunction is not just an inherent feature of old age but a clinical indication of poor health and should be considered a symptom not a disease.

Erectile dysfunction requires holistic management of co-existing conditions in conjunction with treatments for the erectile dysfunction itself.

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