Management of Impotence

 

1)      Identify the problem- ? premature ejaculation, decreased libido, etc

2)      If erectile dysfunction consider organis or psychogenic causes

3)      To differentiate consider

a.      Morning erection?

b.      Erection on masturbation?

c.      Difficulty achieving vs maintaining erections

d.      Symptoms of depression?

e.      Patients own assessment of problem

f.        Onset of problem sudden vs gradual?

 

 

4)      Organic

a.      Enquire about vascular risk factors

b.      Drugs taken e.g. EtoH, B-Blockers

c.      Spinal cord diease or symptoms thereof

d.      Hypogonadism (remember to rule out prostate cancer, OSA, polycythaemia before commencing testosterone)

 

 

5)      Psychogenic

a.      Important to assess the couple together e.g. relationship problems, sexual technique problem?

b.      General health of couple?

 

 

TREATMENT

 

Organic Sildenafil (1 hour before sex)

Injections PGE1 injection, penile suppository

Rubber constriction devices, vacuum pump

Penile prosthesis

 

Psychogenic- Relationship conselling

Stress mangement