New Guidelines for Sexual Medicine
Erectile dysfunction (ED) is a highly prevalent disorder associated with a
significant burden of illness. The prevalence and incidence of ED are
strongly age-related, affecting more than half of men >60 years. The first
Princeton Consensus Conference (Princeton I) in 1999 developed guidelines
for safe management of cardiac patients regarding sexual activity and the
treatment of ED.
Aim.
The second conference (Princeton II) was convened to update the
recommendations based on the expanding knowledge base and new treatments
available. This article reviews and expands on the Princeton II guidelines
to address sexual dysfunction and cardiac risk.
Methods.
A consensus panel of experts reviewed recent multinational studies in safety
and drug interaction data for three phosphodiesterase type 5 (PDE5)
inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety
of these agents in men with ED and concomitant cardiovascular disease.
Results.
Erectile dysfunction is an early symptom or harbinger of cardiovascular
disease, due to the common risk factors and pathophysiology mediated through
endothelial dysfunction. Major comorbidities include diabetes, hypertension,
hyperlipidemia and heart disease. Any asymptomatic man who presents with ED
that does not have an obvious cause (e.g., trauma) should be screened for
vascular disease and have blood glucose, lipids, and blood pressure
measurements. Ideally, all patients at risk but asymptomatic for coronary
disease should undergo an elective exercise electrocardiogram to facilitate
risk stratification. Lifestyle intervention in ED, specifically weight loss
and increased physical activity, particularly in patients with ED and
concomitant cardiovascular disease, is literature-supported.
Conclusions.
The recognition of ED as a warning sign of silent vascular disease has led
to the concept that a man with ED and no cardiac symptoms is a cardiac (or
vascular) patient until proven otherwise. Men with ED and other
cardiovascular risk factors (e.g., obesity, sedentary lifestyle) should be
counseled in lifestyle modification.
Reference:
J Sex Med. 2006 Jan;3(1):28-36 |