1. ERECTILE DYSFUNCTION ___________________________ FOR THE GENERALIST

2. ERECTILE DYSFUNCTION ___________________________ DEFINITION THE PERSISTENT INABILITY TO ACHIEVE OR MAINTAIN ERECTION SATISFACTORY FOR SEXUAL PERFORMANCE

3. ERECTILE DYSFUNCTION SCOPE AND IMPACT __________________________ ERECTILE DYSFUNCTION 30 MILLION MEN IN THE USA 40% PREVALENCE AMONG MEN > 40 70% PREVALENCE AMONG MEN > 70

6. Anatomy and Mechanism of Penile Erection

7. Molecular Mechanism of Penile Smooth-Muscle Relaxation

8. Molecular Mechanism of Penile Smooth-Muscle Contraction

10. ERECTILE DYSFUNCTION HISTORY-TAKING ERECTILE DYSFUNCTION SEQUENCE DICTION ATTITUDE LEVEL OF DETAIL

11. ERECTILE DYSFUNCTION HISTORY-TAKING OVERCOMING RETICENCE ERECTILE DYSFUNCTION ASSURE CONFIDENTIALITY UNIVERSALIZE EMPATHIZE

12. HISTORY-TAKING USE THE PHASES OF THE SEXUAL RESPONSE CYCLE TO GUIDE YOUR INQUIRY DESIRE EXCITEMENT ORGASM RESOLUTION

13. ERECTILE DYSFUNCTION HISTORY-TAKING ERECTILE DYSFUNCTION PSYCHOGENICORGANIC Onset AbruptGradual Course SelectivePersistent Degree PartialAbsolute Nocturnal or am Erection? YesNo Associated Features Psychosocial stress Organic Disease

15. ERECTILE DYSFUNCTION DIAGNOSIS ERECTILE DYSFUNCTION HISTORY IS (almost) ALL PHYSICAL CONSIDER SERUM TESTOSTERONE OTHER TESTS USUALLY NOT INDICIATED

16. ERECTILE DYSFUNCTION DIAGNOSIS ERECTILE DYSFUNCTION R/O HORMONAL ETIOLOGY R/O SUBSTANCE ABUSE CONSIDER PSYCHOGENIC ETIOLOGY CONSIDER MEDICATION CHANGES TRY TREATMENT

17. Approach to the Diagnosis and Treatment of Erectile Dysfunction

18. Molecular Mechanism of Penile Smooth-Muscle Relaxation

20. PRESCRIBING

21. Start with medium dose Minor side effects – headache, flushing, dyspepsia, nasal discharge, visual change Consider cost and insurance coverage

22. DEATH BY VIAGRA? ________________________________ SAFETY REPORT TO FDA EXPECTED DEATHS PER SECOND HEMODYANIC STUDIES AHA GUIDELINES

23. Deaths Associated with Sildenafil Therapy in the United States

25. ERECTILE DYSFUNCTION Other Oral Meds ERECTILE DYSFUNCTION Yohimbine Trazodone Apomorphine Phentolamine

26. Approach to the Diagnosis and Treatment of Erectile Dysfunction

27. ERECTILE DYSFUNCTION Tranurethral Medication ERECTILE DYSFUNCTION Alprostadil = Muse = Prostaglandin E1 Moderate Efficacy Expensive Causes pain frequently

28. ERECTILE DYSFUNCTION Mechanical Aids ERECTILE DYSFUNCTION Vacuum device Constriction rings

29. ERECTILE DYSFUNCTION Intracavernosal Therapy ERECTILE DYSFUNCTION “Trimix” of alprostadil, phentolamine, papaverine Almost always efficacious Requires referral, training, careful monitoring Risk of priapism and fibrosis

30. ERECTILE DYSFUNCTION Penile Prostheses ERECTILE DYSFUNCTION Effective Major surgery Expensive Significant risk of infection Usually have to be replace after 5-10 years

31. Treatment Options for Men with Erectile Dysfunction