P1: OXT/OZN/JDO P2: PSB
0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10
Erectile Dysfunction 541
Beta-blockers, thiazides, spironolactone, as well as anti-
androgenic drugs (cimetidine, ketoconazole, cyproterone, and
estrogens)
Cigarette smoking via vasoconstriction and penile venous
leakage
Exogenous steroids
Chronic alcoholism: hypogonadism and polyneuropathy
➣Vasculogenic ED
Atherosclerosis, hypertension, hyperlipidemia, cigarette
smoking, diabetes mellitus, and pelvic irradiation, degenera-
tive changes (Peyronie’s disease, old age, diabetes mellitus),
traumatic injury (penile fracture or surgery)
Inadequate arterial inflow and impaired venous occlusion
■Psychogenic
➣Performance anxiety, strained relationship, lack of sexual arous-
ability, and psychiatric disorders (depression and schizophrenia)
➣Secondary to loss of libido, overinhibition, or impaired nitric
oxide release
■Age-related – increased latent period between sexual stimulation
and erection
➣Erections less turgid
➣Ejaculation less forceful, with decreased volume
➣Lengthened refractory period
management
■Occasionally, change in lifestyle or medications all that is needed to
restore potency
■Treat underlying medical condition
specific therapy
Medical
■Androgen therapy offered to men with ED secondary to hypogo-
nadism only
➣Testosterone therapy may increase libido and desire but may not
improve erections
➣Side effects: hepatotoxicity, skin irritation, dermatitis, possible
stimulation of prostate growth (BPH or cancer)
➣Avoid in men with normal hormonal levels and men with prostate
cancer or enlarged prostate with obstructive voiding symptoms
■First-line therapy
➣Oral therapy with phosphodiesterase-5 inhibitor (sildenafil, var-
denafil, tadalafil) considered first line