There is a high prevalence of cardiovascular disease among patients seeking treatment for sexual dysfunction and the potential cardiac risks associated with sexual activity are well established; the latter comes well before with a mean time interval of almost 3 yr. The proposed management recommendations are adapted by the Princeton consensus conference on sexual dysfunction and cardiac risks. Real non-responders to PED5 inhibitors have a severe end-organ failure with an important reduction of its functional smooth muscle musculature. They show severe veno-occlusive dysfunction, with many of them also non-responding to intracavernosal injection of vasoactive drugs. This veno-occlusive dysfunction is often associated with penile arterial blood alterations. The following measures can be used in convincing salvage rates for PDE5 non-responders: 1. Potential benefits of lifestyle changes may be of special relevance in patients with ED and specified co-morbid cardiovascular or metabolic diseases. 2. Education and re-counselling of the patient/couples in the proper use of oral therapy. 3. Treatment of concomitant hypogonadism. Recent studies show the relationship between sex, steroids and cardiovascular disease and it is proven that testosterone regulates the responsiveness to PDE5 inhibitors in the corpus cavernosum. 4. daily dosing with PDE5 inhibitors for several months is able to change endothelial function and therefore to improve ED and cardiovascular function. 5. Beside oral therapy, vacuum device intracavernous injection and/or penile implant can also be used.
Conflict of Interest: Speaker,Study Investigator And Consultant For The Following Companies: Bayer Healthcare, Pfizer Corp., Lilly/Icos, Johnson&Johnson
Financial Support/Funding: None disclosed
Sydney Australia, April 2007
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