Sildenafil: a urologist's view

Erectile dysfunction: a need for greater awareness

Research has led to effective treatment regimes for erectile dysfunction (ED). Convincing evidence links vascular risk factors (hypertension, diabetes mellitus, hyperlipidaemia and smoking) with ED. This association is not surprising since the corpus cavernosum is a modified vascular tissue. This review presents a brief account of the aetiology, diagnosis and treatment of ED. There is a need to raise awareness of this condition and to make appropriate treatment available to patients.

Hypertension, antihypertensive therapy, and erectile dysfunction

Erectile dysfunction represents a common problem in the male hypertensive population. Both erectile dysfunction and hypertension share common pathophysiologic pathways such as atherosclerosis and endothelial dysfunction. Furthermore, traditional cardiovascular risk factors affect both conditions. Notably, several antihypertensive medications seem to adversely affect erectile function whereas others may exert neutral or even favorable effects. Thus, the regular and meticulous clinical evaluation of hypertensive patients, as well as individualization of anti-hypertensive therapy, are important steps in the effective management of such patients. In addition, the administration of phosphodiesterase-5 inhibitors or apomorphine has excellent efficacy and safety profile in hypertensive patients irrespective of taking or not taking antihypertensive medications.

Diabetes, hypertension and erectile dysfunction

Diabetes mellitus (DM) and hypertension are independent risk factors for erectile dysfunction (ED), macrovascular disease and microangiopathy. ED is very common among diabetic patients. Men with DM have ED at an earlier age and with a significantly higher prevalence (as high as 75%). The prevalence of DM also tends to be higher in patients with Peyronie's disease. DM impairs neurogenic and endothelium-mediated relaxation of penile smooth muscle. It is impossible to separate DM from hypertension and from the other vascular risk factors. Good glycaemic and hypertension control in diabetics is very important since these factors increase the risk of both microvascular and macrovascular complications, possibly including ED.