Current Treatment For Erectile Dysfunction
Arousal disorders in men are more likely to be inadequate genital arousal disorder (erectile dysfunction) and hypersexuality, whereas women are more likely to present with inadequate mental arousal disorder. For both sexes, arousal disorders markedly affect physical and emotional satisfaction.
Erectile dysfunction (impotence) is extremely common in older men. The most common cause is atherosclerosis, resulting in poor blood flow to the penile artery and venous leaks. Other causes include medications, endocrine conditions (e.g., prolactinoma, hypothyroidism, hyperthyroidism, diabetes mellitus), neuropathy, lumbar spinal stenosis, multiple sclerosis, and epilepsy. Cigarette smoking markedly increases the likelihood of males developing erectile dysfunction. Psychological causes of erectile dysfunction are rare in older men, although performance anxiety may worsen organic disease.
Older males with erectile dysfunction are very likely to have vascular disease in other organs. Thus, it is important to screen in these men for coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Because men tend not to consult physicians as often as do women, it is important that, when men present with erectile dysfunction, these and other health issues are addressed.
Current treatment for erectile dysfunction is a phosphodiesterase-5 inhibitor such as sildenafil (Viagra), tadafil (Cialis), Cialis Professional or vardenafil (Levitra). These drugs cannot be used in males taking nitrates, and they need to be used with caution in men taking adrenergic blockers. Side effects include hypotension, syncope, indigestion, headache, and blindness. The response to phosphodiesterase-5 inhibitors is poor in hypogonadal (low-testosterone level) men and can be improved with testosterone replacement.
Other treatments include intracavernosal (into the penis tissues) injections with alprostadil, papaverine, or phentolamine and insertion of a penile prosthesis. Safe sex needs to be emphasized with all men undergoing treatment for erectile dysfunction. A number of studies have shown that the most frequent use of prostitutes occurs on the days Social Security checks become available.
The health care provider needs to be aware that homosexuality occurs as commonly in older men as in younger men. Because of previous social mores, many older men have been unable to declare their sexual preference, and family conflict can erupt when an older man begins a homosexual relationship. A number of social issues, particularly the right to allow a lifelong male partner to make health decisions or issues associated with inheritance, can be obstacles to appropriate health care. The health practitioner needs to be aware of the possibility of AIDS in older gay men. In the United States, the most rapid increase in AIDS is occurring in men over 60 years of age.