1. Erectile Dysfunction Stephen Mark Christchurch

2. Normal erectile function: Physical and Psychological factors

3. Erectile function is about performance

6. Erectile dysfunction is common

8. Causes of Erecitle dysfunction Performance anxiety

9. Heart and Vascular disease

10. Depression

11. Diabetes

12. Drugs: over 200 drugs antihypertensives heart medication antidepressants alcohol

13. smoking Stopping smoking does improve erectile function

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

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

16. Background Original drug developed for BP Patented 1996 1999-2001 over $1 billion sales First drug direct to patient advertisement Online prescription 10X Off patent 2011

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

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

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

20. 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

22. Second generation PDE5 inhibitor

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

24. Marketing ED drugs Controversial Improved patient awareness More open discussion Intrusive

25. Levitra Similar to Viagra minimal marketing 7% market share

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

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

28. Vacuum devices Improves poor quality erection useful aid uncomfortable

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

32. The End