Guidelines for Treatment of Erectile Dysfunction

Each patient with erectile dysfunction should receive individualized and integrated treatment of his erectile dysfunction, with all indicated modalities applied.
The first step after the thorough evaluation, diagnosis determination, and patient education should be the modification of reversible causes, such as alcohol abuse, smoking, prescription or nonprescription drugs, and cardiovascular risk factors (e.g. hypertension).
 Some authors divide the possible treatment interventions into first-, second-, and third-line ones. According to Goldstein (1999), the first-line interventions include oral erectogenic agents (e.g., sildenafil, oral apomorphine, oral phentolamine), vacuum erectile devices, and psychosexual therapy. These interventions are easy to administer, noninvasive, and reversible. Mobley and Baum (1998) also include all of these modalities in their first-line therapies, with the addition of yohimbine.....

Causes of Erectile Dysfunction

As Schiavi pointed out in the previous edition of this book, “emphasis on specific determinants of erectile disorders has been influenced by prevailing theoretical perspectives as they have shifted over the time”. We have certainly seen a shift from the emphasis on psychological causes or determinants of erectile dysfunction to an emphasis on biological or organic causes of erectile dysfunction. The previous claims that 90%-100% of erectile dysfunctions have psychological origins changed to claims that 90%-100% of erectile dysfunctions have biological or organic causes. However, every experienced clinician in this area knows that the etiology of erectile dysfunction is usually multidetermined, involving a mixture of organic and psychological factors. Even an unequivocally biologically determined erectile dysfunction, such as erectile dysfunction associated with diabetes mellitus, has a psychological component.