A new era in the treatment of erectile dysfunction

The recent introduction of sildenafil has revolutionized the treatment of e rectile dysfunction (ED). The availability of sildenafil, the first effecti ve oral agent for ED, has also expanded the field of sexual healthcare to i nclude general and primary care practitioners and other nonurology speciali sts. A new process-of-care algorithm has been developed to facilitate the e valuation and treatment of ED in these nonurology settings. Sildenafil has been demonstrated to be safe and effective in randomized, double-blind, pla cebo-controlled trials involving >3,000 men ages 19-87 years. Sildenafil is effective across a broad range of etiologies including diabetes. For patie nts in whom first-line treatment with sildenafil fails or ceases to be effe ctive, second-line interventions with intracavernosal self-injection therap y or transurethral alprostadil may be indicated. In addition to sildenafil, other oral agents such as oral phentolamine and sublingual apomorphine are now in clinical trials. Drugs under development include second-generation phosphodiesterase type 5 (PDE5) inhibitors, endothelin antagonists, and age nts that offer specific molecular targeting. Clinical studies are also bein g planned to examine the efficacy of combination oral drug regimens for ED. (C) 1999 by Excerpta Medica, Inc.