Management
In the absence of a specific correctable aetiology, the
management of erectile dysfunction is largely empirical and performed in a step-wise manner. That is, initial treatment is based on lifestyle modification followed by first-line therapies using PDE5 inhibitors and vacuum erection devices (VEDs).
Second-line therapies consist of an intraurethral suppository (IUS) of prostaglandin E1 (alprostadil) and intracavernosal
injection (ICI) with vasoactive substances. Surgical intervention is reserved as the final option after conservative options have been discussed or attempted.
Lifestyle modification
Lifestyle modifications can have a major role in managing erectile dysfunction,
especially in the younger patient. The physician can identify reversible risk factors that contribute to the patient’s erectile dysfunction, such as medications, poor diet, low exercise, endocrinopathies and anxiety. Although epidemiological evidence seems to support a role for lifestyle factors in erectile dysfunction, limited data are available, suggesting that the treatment of underlying risk factors and coexisting illnesses will ultimately improve erectile dysfunction110. The major limitation remains the paucity of interventional studies assessing the effect of lifestyle changes on erectile function.
The available data support the recommendation that adults should do 30 minutes of moderate-intensity aerobic activity most days of the week110. Weight loss in obese men, and switching from a Western diet to a Mediterranean diet, plus exercise, has been shown to improve erectile dysfunction outcomes111–113.
