It is widely recognized and accepted that erectile dysfunction may be associated with loss of self-esteem and self-confidence, depression, anxiety, relationship strain and other forms of interpersonal intrapersonal distress. Consequently, when phosphodiesterase type 5 inhibitors are successful in restoring or improving sexual function, the psychological and relationship problems associated with erectile dysfunction often improve as well. These drugs are effective in significantly improving erectile function and producing satisfactory sexual performance in about two-thirds of men who try them. There is now ample evidence that PDE5 inhibitors improve not only erectile function but sexual and relationship satisfaction as well. For example, recent double-blind placebo-controlled (DBPC) studies 1,2 have shown statistically highly significant differences favoring sildenafil over placebo as measured by the Self-Esteem and Relationship (SEAR) questionnaire and the erectile function domain of the International Index of Erectile Function (IIEF). In these studies, mean overall SEAR scores increased from 40 at baseline to 76 on sildenafil but only to 47 on placebo. IIEF erectile domain scores improved from 13 at baseline to 25 on sildenafil but only to 16 on placebo in these studies. Many other studies confirm these findings, including a pooled analysis of 26 DBPC studies.3 Moreover, other studies reflect similar improvements in relationship satisfaction and satisfaction with treatment among the partners of men who have been treated for erectile dysfunction with PDE5 inhibitors.4 Despite these excellent results, PDE5 inhibitors cannot be considered a panacea for sexual dysfunction because about one-third of men are non-responders to these drugs. 1 Althof SE, O’Leary MP, Cappelleri JC, et al. J Urol 176: 2132, 2006 2 O’Leary MP, Althof SE, Cappelleri JC, et al. J Urol 176: 1058, 2006 3. Levinson IP. J Sex Med 2 (Suppl) : 59, 2005 4. Muller MJ, Ruof J, Graf-Morganstern M, et al. Pharmacopsychiatry 34 : 91, 2001.
Conflict of Interest: Consultant And Speaker For Pfizer, Lilly, Bayer, Gsk And Schering Plough
Financial Support/Funding: None disclosed
Sydney Australia, April 2007
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