Erectile dysfunction

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The marketing of a safe, convenient and effective treatment for a common problem - Sildenafil for erectile difficulty - in 1998 produced the first explicit rationing rules in the UK NHS.

Apparent failure in this as in other treatments may be due to the patient not having tried a sufficient dose in the correct way[1]. See also concordance.



Psychological factors were emphasised prior to the launch of Sildenafil. Since then a view of mixed physical and psychological factors has been more widely held. The principal physical factor is the lumen of the penile arteries. As would be expected, smokers and those with atherosclerosis elsewhere tend to suffer, and coronary artery insufficiency tends to follow penile arterial insufficiency by a few years.


  • Physical

- Vacuum devices

- Penile prostheses, semi-rigid or inflatable

  • Pharmacological

- Phosphodiesterase-5 inhibitors, such as sildenafil, vardenafil, and tadalafil

- Prostaglandin E1 (alprostadil), either intra-urethrally (MUSE) or intracavernosally (e.g., Caverject, Viridal)


  • Clinical Evidence rate Intracavernosal alprostadil, Intraurethral alprostadil (in men who had responded to a single test dose), Sildenafil, and Yohimbine as being ‘Beneficial’. It rated Topical alprostadil as being a ‘Trade off between benefits and harms ’Clinical Evidence.
  • Bandolier section on erectile dysfunction and premature ejaculation.
  • BASHH/Erectile Dysfunction Alliance guideline.
  • NLH Q&A Service published in 2007 a list of recent guidelines. (Archived)
  • NLH Q&A Service. The role of testosterone in erectile dysfunction. (Archived)
  • eMedicine chapter.


  1. Eardley, I. Optimisation of PDE5 Inhibitor Therapy in Men with Erectile Dysfunction: Converting "Non-Responders" into "Responders". European Urology, Vol. 50, July 2006, pp. 31-33, , pp. 126-133,pp. 134-40.
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