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  • 1.Ika Puspita Sari Bag. Farmakologi & Farmasi Klinik Fakultas Farmasi UGM Ika.puspitasari@gmail.com

2. The inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. The inability to attain or sustain an erection adequate for sexual stimulation Most men experience this at some point in their lives, usually by age 403/8/2013Sari IP UGM2 3. Incidence 20-30 million American men suffer ED Age dependent 2% men age 75 years Not a necessary occurrence of the aging process 4. ERECTILE DYSFUNCTION Impotence As many as 30 million men in North America sufferfrom some degree of erectile dysfunction The probability of a man between 40 and 70 years of age having some degree of erectile dysfunction is 52%3/8/2013Sari IP UGM4 5. 3/8/2013Sari IP UGM5 6. The International Index of Erectile Function (IIEF-5) Questionnaire Reprinted by permission from Macmillan Publishers Ltd: Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. 19993/8/2013Sari IP UGM6 7. 3/8/2013Sari IP UGM7 8. 3/8/2013Sari IP UGM8 9. 3/8/2013Sari IP UGM9 10. Erectile dysfunction is divided into two etiologic categories: psychogenic and organic. Most causes of erectile dysfunction were once considered to be psychogenic, but current evidence suggests that up to 80 percent of cases have an organic cause NIH Consensus Conference on Impotence. JAMA. 1993;270:8390.Organic causes are :vasculogenic, neurogenic and hormonal etiologies3/8/2013Sari IP UGM10 11. The severity of erectile dysfunction is often described as mild, moderate or complete, although these terms have not been precisely defined. The male sexual response cycle consists of four major phases: (1) desire, (2) arousal (erectile ability), (3) orgasm and (4) relaxation. Disorders and dysfunction may occur in one or more of these phases,6 and the clinician evaluating sexual function problems must clarify which phase is primarily responsible for the patient's symptoms.3/8/2013Sari IP UGM11 12. ERECTILE DYSFUNCTION Risk Factors Age (Biggest Risk)* Diabetes* Hypertension* Elevated Total or Low HDL Cholesterol* Medicines (hypoglycemic agents, vasodilators, antihypertensives,antidepressants)* Smoking** Depression Obesity* Massachusetts Male Aging Study ** Mannino et. al. Am. J. Epidemiol. 140(11):1003-8 3/8/2013Sari IP UGM12 13. Conditions Associated with Erectile Dysfunction Aging Chronic diseasesDM, CHD, Hypertension,Lipid, Liver, Renal. VascularEndocrine abnormalitiesHypogonad, Hyper Prl, Hypo/hyper TiroidNeurogenicSpinal cord, multiple scl, herniated discTrauma/injury (pelvic, penile)Peyronie's disease, priapismPelvic radiation Psychologic issues Life style, Medication3/8/2013Depression, anxiety, social stressor Cigaret, alcoholSari IP UGM13 14. Diabetic Control vs ED The better the diabetes control, the better the erections Hemoblobin A1c(blood test that measures diabetes control) Diabetic Neuropathy (pain or numbness in hands and feet) Control weight Improve exercise levelRomeo, J.H, et.al. J. Urol. 163(3), 2000 3/8/2013Sari IP UGM14 15. 3/8/2013Sari IP UGM15 16. Causes of ED Other risk Factors Diabetes Chronic renal failure Hepatic failure27% - 59% 40% 25% - 70% Multiple Sclerosis Severe depression71%90% Other (vascular disease, low HDL, high cholesterol) Benet et al. Urol Clinic North Am. 1995; 151:54-61 17. Causes of ED Risk Factors Massachusetts Male Aging Study Treated heart disease39% Treated diabetes28% Treated hypertension15%Feldman Ha, J Urol 1994; 151:54-61 18. Causes of ED Spinal cord injuries: 5% - 80% Pelvic and urogenital surgery and radiation Substance abuse Alcohol: >600ml/wk Smoking amplifies other risk factors Medications may be responsible for ~25% of cases of ED Bicycle riding 19. Causes of ED Medication: Most common cause of ED in men >50 Many men are polymedicated Also have co-morbid conditions 20. Medication Antihypertensive medications DiureticsType of sexual dysfunction*Thiazides Spironolactone (Aldactone)Erectile dysfunction, decreased libido Erectile dysfunction, decreased libidoCentral agents (methyldopa [Aldomet], clonidine [Catapres]) Peripheral agents (reserpine [Serpasil]) Alpha blockersErectile dysfunction, decreased libidoSympatholyticsBeta blockers (particularly nonselective agents) Psychiatric medications Antipsychotic agents AntidepressantsErectile dysfunction, ejaculatory dysfunction Erectile dysfunction, ejaculatory dysfunction Erectile dysfunction, decreased libidoMultiple phases of sexual function Tricyclic antidepressants Decreased libido, erectile dysfunction Monoamine oxidase inhibitors Multiple phases of sexual function Selective serotonin reuptake inhibitors Ejaculatory dysfunction, erectile dysfunctionAnxiolytic agents BenzodiazepinesDecreased libidoAntiandrogenic Digoxin (Lanoxin) Histamine H2-receptor blockersDecreased libido, erectile dysfunction Decreased libido, erectile dysfunctionOthers Alcohol (long-term heavy use) Ketoconazole (Nizoral) Niacin (Nicolar) Phenobarbital Phenytoin (Dilantin)Decreased libido, erectile dysfunction Decreased libido, erectile dysfunction Decreased libido Decreased libido, erectile dysfunction Decreased libido, erectile dysfunction3/8/2013Sari IP UGM20 21. A Practical Evaluation of Men with ED Sexual History Premature ejaculation Retarded ejaculation Painful intercourse Anorgasmia Decreased Libido Dissatisfaction with sex life 22. A Practical Evaluation of Men with ED Differentiating Psychogenic from Organic ED Organic ED: Gradual deterioration Decrease in morning erections and nocturnal erections No erections with masturbation No loss of libido Presence of co-morbid conditions 23. A Practical Evaluation of Men with ED Differentiating Psychogenic from Organic ED Psychogenic Impotence: Younger patient (

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