Cardiovascular disease and erectile dysfunction - Clinical Opal
Vince is a 58-year-old male. He is a social smoker and has a family history of heart disease.
Physical examination indicates Vince is overweight and well virilised. His waist circumference is 104cm and weight is 98kg. His blood pressure is 160/94.
Clinical investigations show:
- fasting blood glucose: 5.2 mmol/L
- fasting lipids:
- total cholesterol: 5.8 mmol/L
- triglycerides: 2.3 mmol/L
- HDL-chol: 0.9 mmol/L
- LDL-chol: 4.4 mmol/L
Key areas of concern are the heart disease risk factors including:
- high BP
- smoker
- family history of heart disease
- waist circumference greater than 100 cm
- hyperlipidaemia
At this stage you have excluded any further cardiovascular or endocrine conditions.
Given Vince’s age and health status, you ask Vince about his sexual function. Vince reports low libido and difficulty in maintaining an erection.
What treatments may assist Vince in managing erectile function whilst addressing lifestyle factors for cardiovascular health?
For some men with erectile problems it is important to talk about the first line of treatment, which is to alter modifiable risk factors and causes and address any impacts that current medications may be having on sexual function. Once this is addressed consider any psychosocial factors that may be contributing.
Consider prescription of a PDE5 inhibitor:
When prescribing PDE5 inhibitors (either on-demand dosing or daily dosing regimens):
-
adapt dose as necessary, according to the response and side-effects.
-
ensure patient knows that sexual stimulation is required for drug to work: the tablets alone don’t give you an erection.
-
contraindicated in patients who take long-acting nitrates, short-acting, nitrate-containing medications, or recreational nitrates (amyl nitrate).
-
exercise caution when considering PDE5 inhibitors for patients with: active coronary ischaemia, congestive heart failure and borderline low blood pressure, borderline low cardiac volume status, a complicated multi-drug antihypertensive program, or using any drug therapy that can prolong the half-life of PDE5 inhibitors.
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investigate chest pain previously not clinically assessed or undue shortness of breath.
In this case it is safe to prescribe the PDE5 inhibitor however further consultation with the patients’ cardiologist is recommended when considering prescription.
Related Content and Further Learning
- Male sexual function: supporting patients in primary care online learning course
- Erectile dysfunction clinical summary guide
References
1. Yafi et al., 2016. Erectile dysfunction. Nature Reviews Disease Primers. Available from:
https://www.nature.com/articles/nrdp20163
2. Sooriyamoorthy & Leslie 2021. Erectile Dysfunction. In: StatPearls. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Associate Professor Tim Moss, Health Content Manager, Healthy Male
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