Erectile Dysfunction

Stephen MarkChristchurch

Normal erectile function: Physical and Psychological factors

Erectile function is about performance

Erectile dysfunction is common

Causes of Erecitle dysfunction

Performance anxiety

Heart and Vascular disease

Depression

Diabetes

Drugs:

over 200 drugs

antihypertensives

heart medication

antidepressants

alcohol

smoking

Stopping smoking does improve erectile function

Effective treatment is available: at a cost…...

Reducing risk factors and psychological treatment has little effect

Drug therapy: PDE5 Inhibitors

10 years since launch

NZ: 150,000 units ( 4 tablets) annually

61% market share

Background

Original drug developed for BP

Patented 1996

1999-2001 over $1 billion sales

First drug direct to patient advertisement

Online prescription 10X

Off patent 2011

Viagra is effective!

…other uses…

Sports performance

Altitude sickness

Jet lag

Prevent plant wilting

Contraindications PDE5 Inhibitors

Recent MI/CVA

Patients on nitrates

Unstable CV disease

Liver disorders

Drug dosing

Initial dose 50 mg

Increase to 100mg if not effective

By 4th dose standard effect

Delayed absorption by alcohol and fatty foods

Is Viagra effective in men without ED

Definitely safe

EAU 2008 Placebo controlled RCT in men without ED

Men have a “real” benefit in quality and durability of erections

Second generation PDE5 inhibitor

Cialis

Longer acting… up to 48 hours

Less effect with alcohol and fat

31% market share

Marketing ED drugs

Controversial

Improved patient awareness

More open discussion

Intrusive

Levitra

Similar to Viagra

minimal marketing

7% market share

Online sales

Little info

significant fraud

more than 10X prescription sales

Injectable agents

Alprostadil/Caverject or other mixtures

direct vasodilators

over 80% effective

poor long term use

Post radical prostatectomy

Vacuum devices

Improves poor quality erection

useful aid

uncomfortable

Penile Prosthesis

Expensive so low utilisationUse: trauma, post radicalExcellent results

The End