The Treatment of Organic Erectile Dysfunction

The treatment of impotence, more precisely termed erectile dysfunction, has received

increasing attention in recent years. There are, however, considerable gaps in the knowledge

base. Little is yet known about prevalence and how it varies relative to such factors as patient

age, race, ethnicity and concomitant disease. There is much to be learned as well about the

pathophysiology of erectile dysfunction. Although research in this area continues to burgeon,

often the pathophysiology cannot be accurately classified in an individual patient.

 

Nevertheless, the greater attention being given erectile dysfunction has begun to bear fruit

in the form of improved diagnostic methodologies and new and improved nonsurgical treat-

ment methods. Many patients and health care providers may not yet be fully aware of today’s

treatment options, but awareness is spreading rapidly; and treatment of erectile dysfunction

now constitutes a sizable portion of the average urologist’s practice.

 

To provide guidance regarding therapies for erectile dysfunction, the American Urological

Association (AUA) convened the Erectile Dysfunction Clinical Guidelines Panel and charged

it with the task of producing practice recommendations based primarily on outcomes evi-

dence from the treatment literature. The result of the panel’s efforts is this 

Report on the Treatment of Organic Erectile Dysfunction.

 

The panel was charged with producing recommendations to assist physicians specifically

in the treatment of acquired organic erectile dysfunction. The panel took diagnostic factors

into consideration when necessary, but the focus of this report is the treatment of erectile dys-

function. The report also deals only peripherally with psychological factors and with other

forms of sexual dysfunction such as libido and ejaculatory disorders. The definition of the

standard patient is a man who develops erectile dysfunction after a well-established period of

normal erectile function and whose erectile dysfunction is primarily organic rather than psy-

chological and who has no evidence of hypogonadism or hyperprolactinemia.

 

The panel recognizes, however, that it is important for urologists to diagnose and treat sexual

problems due to primary endocrine disorders. The panel also recognizes that there is fre-

quently a psychogenic overlay in the etiology of organic erectile dysfunction and there may

be a need with particular patients to combine different types of treatment, including sexual

counseling and in some cases psychotherapy.

 

In general, treatment of erectile dysfunction is a rapidly evolving therapeutic area, but with

various treatment choices and no clearly dominant therapy to date, making it an especially

appropriate area for the kind of evidence-based practice recommendations offered in this

report. A summary of this report has been published in the Journal of Urology (December 1996),

and A Patient’s Guide with illustrations of recommended treatments is available for purchase

through the AUA.