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Erectile dysfunction.

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VOL: 101, ISSUE: 04, PAGE NO: 28

What is it?

What is it?
- Erectile dysfunction (ED) is the persistent inability to obtain or maintain an erection adequate for satisfactory sexual performance.

- Severity can be assessed using the ED intensity scale.

Causes
- It used to be thought that psychological problems were the main cause of ED. However, there are many organic causes.

- Risk factors for other conditions such as cardiovascular disease may also be associated with ED.

- Medications for some chronic conditions, including hypertension, depression, oesophageal reflux, diabetes and rheumatoid arthritis, may cause ED or increase severity.

- Organic and psychological factors may have a combined effect.

Diagnosis
- Obtain medical and sexual history.

Examine the external genitalia.

Measure blood pressure, fasting blood glucose and plasma lipids.

- If clinically indicated, assess testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin and prostate specific antigen (PSA).

Impact
- ED can be just as devastating for men who are not in a relationship as for those who are.

- Self-esteem can be severely affected by ED and anxieties about developing a sexual relationship can have a major impact on wellbeing.

Treatment options
- A change of lifestyle, such as improving fitness, weight loss, smoking cessation and reducing alcohol intake can sometimes improve erectile function.

- Oral pharmacotherapy is typically the first line of treatment.

- Intraurethral alprostadil consists of a pellet that is inserted into the urethra.

- Intracavernosal alprostadil requires the patient to be taught how to self-inject the shaft of the penis.

- Non-pharmacological treatment options include vacuum device therapy.

- A penile implant may be surgically inserted when all other therapeutic options have been tried and failed.

- Government guidance recommends that patients can receive four treatments each month if they also suffer from: diabetes; multiple sclerosis; spinal cord injury; prostate cancer; chronic renal failure requiring replacement therapy; radical pelvic surgery; single gene neurological disease; prostatectomy; poliomyelitis; spina bifida; Parkinson's disease; or severe pelvic injury.

- There is a 'severe distress' category that allows patients to have treatment prescribed in the secondary care setting.

- Patients are also eligible to receive NHS prescriptions if they have been diagnosed with ED and have received treatment since 14 September 1998.

- Psychosexual counselling can be very effective, especially if both the patient and his partner are able to attend.

Further information
British Association of Sexual and Relationship Therapists (BASRT) www.basrt.org.uk

Relate www.relate.org.uk

Sexual Dysfunction Association www.sda.uk.net

Nurse Education in Erectile Dysfunction (NEED) - supported by Pfizer.

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