Erectile dysfunction is often multifactorial and its management requires that a series of steps be taken. Hatzichristou and Pescatori reported a sequential algorithm for the management of a male with erectile dysfunction (ED). This was based on one published by Jardin et al.
Therapy starts at the simplest and safest intervention. If this fails to achieve the expected result then the next step is tried.
Step
Therapeutic Maneuver
1
Identify and modify lifestyle factors.
2
Therapy with a phosphodiesterase 5 (PDE5) inhibitor unless there are contraindications.
3
Sexual counseling and education on reasonable expectations.
4
Combination drug therapy.
5
Vacuum device.
6
Intracavernosal injection or intraurethral prostaglandin E1 application.
7
Surgery (implanted prosthesis, vascular)
where:
• The second step of the original algorithm combined Steps 2 and 3 above.
• The original algorithm did not have a step for combination drug therapy.
• The third step of the original algorithm combined Steps 5 and 6 above.
Lifestyle factors may include:
(1) diet
(2) medications
(3) stress
(4) conflict with partner
(5) cigarette smoking
(6) drug or alcohol abuse
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