Sexual trauma and erectile dysfunction

Merck Manual

Commonly Used Drugs That Can Cause Erectile Dysfunction

Class

Drugs

Antihypertensives

β-Blockers, , loop diuretics (probably), , thiazide diuretics

CNS drugs

Alcohol, anxiolytics, cocaine, monoamine oxidase inhibitors, opioids, SSRIs, tricyclic antidepressants

Others

Amphetamines, 5α-reductase inhibitors, antiandrogens, cancer chemotherapy drugs, anticholinergics, , , luteinizing hormone‒releasing hormone agonists and antagonists

Treatment

Underlying organic disorders (eg, diabetes, hypogonadism, Peyronie disease) require appropriate treatment. Drugs that are temporally related to onset of ED should be stopped or switched. Depression may require treatment. For all patients, reassurance and education (including of the patient's partner whenever possible) are important.

For further therapy, an oral phosphodiesterase inhibitor is tried first. If necessary, another noninvasive method, such as a vacuum erection device or intracavernosal or intraurethral prostaglandin E1 is tried next. Invasive treatments are used only when noninvasive methods fail. All drugs and devices should be tried ≥ 5 times before being considered ineffective.

Drugs:

First-line treatment of ED is usually an oral phosphodiesterase inhibitor. Other drugs used include intracavernosal or intraurethral prostaglandin E1. However, because almost all patients prefer oral drug therapy, oral drugs are used unless they are contraindicated or not tolerated.

Oral phosphodiesterase inhibitors selectively inhibit cyclic guanosine monophosphate (cGMP)–specific phosphodiesterase type 5 (PDE5), the predominant phosphodiesterase isoform in the penis. These drugs include, , avanafil, and (see Table 2: Oral Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction). By preventing the hydrolysis of cGMP, these drugs promote the cGMP-dependent smooth muscle relaxation that is essential for normal erection. Although and are more selective for the penile vasculature than, clinical responses and adverse effects of these drugs are similar. In comparative clinical trials, these drugs show comparable efficacy (60 to 75%).

Table 2

Oral Phosphodiesterase Type 5 Inhibitors for Erectile Dysfunction

Drug

Dose*

Onset of Action

Comments

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Sexual issues-should I leave him?

by -

Dating a guy who isn't everything I wanted, but seemed to be a good long term choice.
He has a psychological erectile dysfunction and we've tried doing it for the past month--no luck. He's early 30s and has only slept with 2 other women before--and it's been about a year since his last sex.
To make matters worse he suddenly has this bump/wart on his dick, which I noticed, that might be HPV genital warts. His doctor referred him to a specialist which he is going to see within the next week.
I told him to be honest with me and tell me the truth about when he had last sex (if it was really over a year ago) so I could figure out this possible STD thing--to rule stuff out--because i've been exposed to this bump

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