Childhood emergencies

May 2010


Erectile dysfunction – when tablets don’t work

Volume 39, No.5, May 2010 Pages 301-305

Ian A R Smith

Nicholas McLeod

Prem Rashid


Erectile dysfunction (ED) is a common clinical problem managed in the general practice setting. While the majority of men will find phosphodiesterase-5 (PDE-5) inhibitors effective, there is a subgroup of men who require second and third line therapies.


This article provides an overview of ED and its management with particular focus on the group of patients in whom oral agents fail.


Erectile dysfunction is a multifactorial condition that affects approximately 40% of Australian men. The incidence of ED is age related however, it shares common risk factors with cardiovascular disease and metabolic disorders. The management of ED should begin with an assessment of cardiovascular risk factors, advice on lifestyle modification, and a trial of PDE-5 inhibitors. Second line therapies include intracavernosal injections and vacuum erection devices, while third line therapy entails penile implants. Factors that influence treatment success include partner inclusion, good patient selection, as well as ongoing support and education.

Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.1 The overall prevalence of ED in Australia is estimated at 40%.2,3 The risk of developing ED is age related, occurring in approximately 26% of men aged 50–59 years, and approximately 40% of men aged 60–69 years.2,4 With the advent of phosphodiesterase-5 PDE-5 inhibitors, the management of ED occurs predominantly in the primary care setting. Risk factors for ED are shown in Table 1. Guidelines for assessment and management of ED are available from Andrology Australia5 (see Resources).

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