New oral agents for erectile dysfunction: what is changing in our practice?

Erectile dysfunction (ED) is a highly prevalent disorder affecting an estim ated 152 million men worldwide and is associated with a variety of behavior al risk factors, such as cigarette smoking and excessive alcohol consumptio n, as well as numerous age - related medical conditions, notably type-2 dia betes mellitus and cardiovascular disease. A rational step - wise approach which includes comprehensive medical and sexual history, a focused physical examination and essential laboratory tests such as fasting glucose, lipid profile and testosterone assay is to be preferred. Current diagnostic work - up does not recommend any of the specialized tests which were previously considered mandatory-i. e. penile pharmacotesting, Duplex ultrasound and no cturnal penile tumescence. Hormonal replacement therapy is appropriate only in the hypogonadal male with ED. Prior to direct intervention, the physici an should consider altering modifiable risk factors or causes, although fre quently insufficient to reverse ED completely. When indicated, oral therapy with new molecules (phosphodiesterase inhibitors or apomorphine) is the fi rst - line treatment for the majority of patients because of potential bene fits and lack of invasiveness.