Erectile Dysfunction - Treatment Options Pamphlet from the CUA
Peyronie’s Disease Pamphlet
Intracavernosal Injection Video - link Youtube
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General Approach to Erectile Dysfunction - (adapted from) CUA 2015 Guidelines
Initial workup: along with history, physical exam, serum glucose or hemoglobin A1C, lipid profile and optional hormonal testing facilitate the diagnosis of ED and effective therapy. Patient history can differentiate ED from other male sexual dysfunctions, including ejaculatory disorders (premature ejaculation and other abnormalities), hypogonadism, disorders of orgasm, and Peyronie’s disease.
Regarding psychological factors: Organic (physical) causes of ED are present in most men, but situational or psychosocial contributing factors often play a contributory role. Addressing these issues may enhance treatment efficacy.
Associated cardiovascular risk factors: Underlying risk factors associated with ED are common to cardiovascular disease in general, and should be identified during evaluation as they may represent the initial clinical sign of generalized endothelial disease (vascular insufficiency). Evaluation of family history, nicotine use, blood pressure, lipid profile, and glucose is required or should be documented if previously performed. Active management of identified cardiac risk factors should be instituted (i.e., smoking cessation, blood pressure treatment).
Initial treatment: Once reversible causes of ED are ruled out, a trial of oral medication is recommended as first-line therapy, based on treatment efficacy, side effect profile, and minimal invasiveness.
Specialized testing and referral are generally reserved for cases where oral first-line treatments fail or are not appropriate, of if greater insight into the etiology is desired by the patient/physician.
Brief overview of Treatment Algorithm:
1. PDE5 inhibitors
2. Testosterone replacement only in documented hypogonadism
3. Sexual counselling
4. Local therapy - such as intracavernosal injection
5. Penile Vacuum device - OSBON.ca
6. Surgery - penile implant/peyronie's repair/rarely vascular surgery
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Counselling and sex therapy
www.bestco.info (Board of Examiners in Sex Therapy Counselling in Ontario).
What is sex therapy?
Sex Therapy involves a range of therapeutic processes and exercises which can be used to initiate, to restore and to enrich both the individual's sexuality and/or the sexual components of an intimate relationship.