Erectile Dysfunction Stephen Mark Christchurch

Normal erectile function: Physical and Psychological factors

Erectile function is about performance

Erectile dysfunction is common

Causes of Erecitle dysfunction Performance anxiety

Heart and Vascular disease

Depression

Diabetes

Drugs: over 200 drugs antihypertensives heart medication antidepressants alcohol

smoking Stopping smoking does improve erectile function

Effective treatment is available: at a cost…... Reducing risk factors and psychological treatment has little effect

Drug therapy: PDE5 Inhibitors 10 years since launch NZ: 150,000 units ( 4 tablets) annually 61% market share

Background Original drug developed for BP Patented over $1 billion sales First drug direct to patient advertisement Online prescription 10X Off patent 2011

Viagra is effective! …other uses… Sports performance Altitude sickness Jet lag Prevent plant wilting

Contraindications PDE5 Inhibitors Recent MI/CVA Patients on nitrates Unstable CV disease Liver disorders

Drug dosing Initial dose 50 mg Increase to 100mg if not effective By 4th dose standard effect Delayed absorption by alcohol and fatty foods

Is Viagra effective in men without ED Definitely safe EAU 2008 Placebo controlled RCT in men without ED Men have a “real” benefit in quality and durability of erections

Second generation PDE5 inhibitor

Cialis Longer acting… up to 48 hours Less effect with alcohol and fat 31% market share

Marketing ED drugs Controversial Improved patient awareness More open discussion Intrusive

Levitra Similar to Viagra minimal marketing 7% market share

Online sales Little info significant fraud more than 10X prescription sales

Injectable agents Alprostadil/Caverject or other mixtures direct vasodilators over 80% effective poor long term use Post radical prostatectomy

Vacuum devices Improves poor quality erection useful aid uncomfortable

Penile Prosthesis Expensive so low utilisation Use: trauma, post radical Excellent results

The End