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Erschienen in: Current Sexual Health Reports 3/2023

24.06.2023

Prescribing PDE5 Inhibitors: Best Practices, Common Practices, and Controversies

verfasst von: Marty R. Klein, Alan W. Shindel

Erschienen in: Current Sexual Health Reports | Ausgabe 3/2023

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Abstract

Purpose of Review

Erectile dysfunction (ED) is an increasingly common concern that has been a topic of interest to men (and their partners) since time immemorial. In the year 2023, we mark a quarter century since selective phosphodiesterase type 5 inhibitors (PDE5I) came to market as the first United States Food and Drug Administration (USFDA) approved oral pharmacotherapy for ED.

Recent Findings

The past 25 years have seen a major shift in public discourse on sexuality and sexual dysfunction, to a large extent prompted by the safety and ease of availability of these drugs. The positive impact of the drug on men and their partners is undeniable. The advent of PDE5I has not been without controversy, and in some regards, the sheer simplicity of the drugs’ use may have compromised consideration of more deep-seated psychological and interpersonal dimensions of sexuality.

Summary

The clear link between ED and cardiovascular disease and even mortality also underscores how simply taking a pill to address the immediate goal of a rigid penis may lead to the person with ED overlooking potentially serious medical problems, of which ED may be a harbinger. In this manuscript, we outline our perspectives on use (and misuse) of PDE5I as a certified sex therapist and a board-certified urologist with interest in sexual medicine. We highlight areas of agreement and disagreement and hopefully provide readers of all disciplines with perspectives on how to optimize sexual wellness for all of our patients, with or without PDE5I.
Literatur
1.
Zurück zum Zitat •• Burnett AL, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–41. The 2018 AUA guideline on erectile dysfunction is the most rigorous, evidence-based document detailing appropriate management of ED. The guideline was generated by thorough review of the peer-reviewed literature with the assistance of a methodologist and was written by a multi-disciplinary team of nationally renowned experts, including patient advocates.CrossRefPubMed •• Burnett AL, et al. Erectile dysfunction: AUA guideline. J Urol. 2018;200(3):633–41. The 2018 AUA guideline on erectile dysfunction is the most rigorous, evidence-based document detailing appropriate management of ED. The guideline was generated by thorough review of the peer-reviewed literature with the assistance of a methodologist and was written by a multi-disciplinary team of nationally renowned experts, including patient advocates.CrossRefPubMed
2.
Zurück zum Zitat Goldstein I, et al. The serendipitous story of sildenafil: an unexpected oral therapy for erectile dysfunction. Sex Med Rev. 2019;7(1):115–28.CrossRefPubMed Goldstein I, et al. The serendipitous story of sildenafil: an unexpected oral therapy for erectile dysfunction. Sex Med Rev. 2019;7(1):115–28.CrossRefPubMed
3.
Zurück zum Zitat Costa P, et al. Impact of a first treatment with phosphodiesterase inhibitors on men and partners’ quality of sexual life: results of a prospective study in primary care. J Sex Med. 2013;10(7):1850–60.CrossRefPubMed Costa P, et al. Impact of a first treatment with phosphodiesterase inhibitors on men and partners’ quality of sexual life: results of a prospective study in primary care. J Sex Med. 2013;10(7):1850–60.CrossRefPubMed
4.
Zurück zum Zitat Gordon E. The ethics of medical sexual health education and its provision. Curr Sex Health Rep. 2022;14:99–105.CrossRef Gordon E. The ethics of medical sexual health education and its provision. Curr Sex Health Rep. 2022;14:99–105.CrossRef
5.
Zurück zum Zitat Faden J, Gorton G. The doorknob phenomenon in clinical practice. Am Fam Physician. 2018;98(1):52–3.PubMed Faden J, Gorton G. The doorknob phenomenon in clinical practice. Am Fam Physician. 2018;98(1):52–3.PubMed
6.
Zurück zum Zitat • Althof SE, Wieder M. Psychotherapy for erectile dysfunction: now more relevant than ever. Endocrine. 2004;23(2-3):131–4. Written relatively early in the PDE5I era, this manuscript articulates how PDE5I are not the “end of history” in terms of ED management. Psychosocial dynamics remain essential to sexual satisfaction so the important role of the sex therapist in management of ED has not been diminished by the advent of highly effective pharmacotherapy for this condition.CrossRefPubMed • Althof SE, Wieder M. Psychotherapy for erectile dysfunction: now more relevant than ever. Endocrine. 2004;23(2-3):131–4. Written relatively early in the PDE5I era, this manuscript articulates how PDE5I are not the “end of history” in terms of ED management. Psychosocial dynamics remain essential to sexual satisfaction so the important role of the sex therapist in management of ED has not been diminished by the advent of highly effective pharmacotherapy for this condition.CrossRefPubMed
7.
Zurück zum Zitat Laumann EO, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57.CrossRefPubMed Laumann EO, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57.CrossRefPubMed
8.
Zurück zum Zitat MacDonald SM, Burnett AL. Physiology of erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2021;48(4):513–25.CrossRefPubMed MacDonald SM, Burnett AL. Physiology of erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2021;48(4):513–25.CrossRefPubMed
9.
Zurück zum Zitat • McCabe MP, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135–43. Sexual problems are complex and oftentimes hard to classify. This consensus document from the International Consultation on Sexual Medicine provides evidence-based recommendations on proper classification of sexual concerns.CrossRefPubMed • McCabe MP, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135–43. Sexual problems are complex and oftentimes hard to classify. This consensus document from the International Consultation on Sexual Medicine provides evidence-based recommendations on proper classification of sexual concerns.CrossRefPubMed
11.
Zurück zum Zitat Fan Y, et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol. 2018;36(10):1681–9.CrossRefPubMed Fan Y, et al. Erectile dysfunction and risk of cardiovascular and all-cause mortality in the general population: a meta-analysis of cohort studies. World J Urol. 2018;36(10):1681–9.CrossRefPubMed
12.
Zurück zum Zitat Inman BA, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84(2):108–13.CrossRefPubMedPubMedCentral Inman BA, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84(2):108–13.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat • Miner M, et al. Erectile dysfunction and subclinical cardiovascular disease. Sex Med Rev. 2019;7(3):455–63. Erectile dysfunction is an important problem in its own right but can be a warning sign of serious health issues, most specifically issues with the cardiovascular system. Patients should be advised that healthy lifestyle choices may help prevent or even reverse ED; motivation to maintain healthy sexual life may yield benefits to other aspects of health and longevity.CrossRefPubMed • Miner M, et al. Erectile dysfunction and subclinical cardiovascular disease. Sex Med Rev. 2019;7(3):455–63. Erectile dysfunction is an important problem in its own right but can be a warning sign of serious health issues, most specifically issues with the cardiovascular system. Patients should be advised that healthy lifestyle choices may help prevent or even reverse ED; motivation to maintain healthy sexual life may yield benefits to other aspects of health and longevity.CrossRefPubMed
14.
Zurück zum Zitat Maiorino MI, et al. Effects of Mediterranean diet on sexual function in people with newly diagnosed type 2 diabetes: the MEDITA trial. J Diabetes Complications. 2016;30(8):1519–24.CrossRefPubMed Maiorino MI, et al. Effects of Mediterranean diet on sexual function in people with newly diagnosed type 2 diabetes: the MEDITA trial. J Diabetes Complications. 2016;30(8):1519–24.CrossRefPubMed
15.
Zurück zum Zitat Esposito K, et al. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res. 2006;18(4):405–10.CrossRefPubMed Esposito K, et al. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res. 2006;18(4):405–10.CrossRefPubMed
16.
17.
Zurück zum Zitat Klein M. His porn, her pain: confronting America’s pornpanic with honest talk about sex. Santa Barbara, CA: Praeger Publishing; 2016. Klein M. His porn, her pain: confronting America’s pornpanic with honest talk about sex. Santa Barbara, CA: Praeger Publishing; 2016.
18.
Zurück zum Zitat Costello EJ, et al. Development and natural history of mood disorders. Biol Psychiatry. 2002;52(6):529–42.CrossRefPubMed Costello EJ, et al. Development and natural history of mood disorders. Biol Psychiatry. 2002;52(6):529–42.CrossRefPubMed
19.
Zurück zum Zitat Shindel AW, et al. Sexual health in undergraduate medical education: existing and future needs and platforms. J Sex Med. 2016;13(7):1013–26.CrossRefPubMed Shindel AW, et al. Sexual health in undergraduate medical education: existing and future needs and platforms. J Sex Med. 2016;13(7):1013–26.CrossRefPubMed
20.
Zurück zum Zitat Veronin MA, Nutan MT, Dodla UK. Quantification of active pharmaceutical ingredient and impurities in sildenafil citrate obtained from the Internet. Ther Adv Drug Saf. 2014;5(5):180–9.CrossRefPubMedPubMedCentral Veronin MA, Nutan MT, Dodla UK. Quantification of active pharmaceutical ingredient and impurities in sildenafil citrate obtained from the Internet. Ther Adv Drug Saf. 2014;5(5):180–9.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Atiemo HO, Szostak MJ, Sklar GN. Salvage of sildenafil failures referred from primary care physicians. J Urol. 2003;170(6 Pt 1):2356–8.CrossRefPubMed Atiemo HO, Szostak MJ, Sklar GN. Salvage of sildenafil failures referred from primary care physicians. J Urol. 2003;170(6 Pt 1):2356–8.CrossRefPubMed
22.
Zurück zum Zitat Mostafa T, Alghobary MF. Recreational use of oral PDE5 inhibitors: the other side of midnight. Sex Med Rev. 2022;10(3):392–402.CrossRefPubMed Mostafa T, Alghobary MF. Recreational use of oral PDE5 inhibitors: the other side of midnight. Sex Med Rev. 2022;10(3):392–402.CrossRefPubMed
23.
Zurück zum Zitat Semple SJ, et al. Sexual marathons and methamphetamine use among HIV-positive men who have sex with men. Arch Sex Behav. 2009;38(4):583–90.CrossRefPubMed Semple SJ, et al. Sexual marathons and methamphetamine use among HIV-positive men who have sex with men. Arch Sex Behav. 2009;38(4):583–90.CrossRefPubMed
24.
Zurück zum Zitat Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. 2011;40(3):597–606.CrossRefPubMed Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. 2011;40(3):597–606.CrossRefPubMed
25.
Zurück zum Zitat Bechara A, et al. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. 2010;7(11):3736–42.CrossRefPubMed Bechara A, et al. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. 2010;7(11):3736–42.CrossRefPubMed
26.
Zurück zum Zitat Mykoniatis I, et al. Assessment of combination therapies vs monotherapy for erectile dysfunction: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(2):e2036337.CrossRefPubMedPubMedCentral Mykoniatis I, et al. Assessment of combination therapies vs monotherapy for erectile dysfunction: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(2):e2036337.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Garrido-Abad P, et al. Combination therapy with topical alprostadil and phosphodiesterase-5 inhibitors after failure of oral therapy in patients with erectile dysfunction: a prospective, two-arm, open-label, non-randomized study. Int J Impot Res. 2022;34(2):164–71.CrossRefPubMed Garrido-Abad P, et al. Combination therapy with topical alprostadil and phosphodiesterase-5 inhibitors after failure of oral therapy in patients with erectile dysfunction: a prospective, two-arm, open-label, non-randomized study. Int J Impot Res. 2022;34(2):164–71.CrossRefPubMed
28.
Zurück zum Zitat Zhang X, et al. Phosphodiesterase-5 inhibitors for premature ejaculation: systematic review and meta-analysis of placebo-controlled trials. Am J Mens Health. 2020;14(3):1557988320916406.CrossRefPubMedPubMedCentral Zhang X, et al. Phosphodiesterase-5 inhibitors for premature ejaculation: systematic review and meta-analysis of placebo-controlled trials. Am J Mens Health. 2020;14(3):1557988320916406.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Shindel AW, et al. Disorders of ejaculation: an AUA/SMSNA guideline. J Urol. 2022;207(3):504–12.CrossRefPubMed Shindel AW, et al. Disorders of ejaculation: an AUA/SMSNA guideline. J Urol. 2022;207(3):504–12.CrossRefPubMed
30.
Zurück zum Zitat Tal R, Teloken P, Mulhall JP. Erectile function rehabilitation after radical prostatectomy: practice patterns among AUA members. J Sex Med. 2011;8(8):2370–6.CrossRefPubMed Tal R, Teloken P, Mulhall JP. Erectile function rehabilitation after radical prostatectomy: practice patterns among AUA members. J Sex Med. 2011;8(8):2370–6.CrossRefPubMed
Metadaten
Titel
Prescribing PDE5 Inhibitors: Best Practices, Common Practices, and Controversies
verfasst von
Marty R. Klein
Alan W. Shindel
Publikationsdatum
24.06.2023
Verlag
Springer US
Erschienen in
Current Sexual Health Reports / Ausgabe 3/2023
Print ISSN: 1548-3584
Elektronische ISSN: 1548-3592
DOI
https://doi.org/10.1007/s11930-023-00367-w

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