the future of sexual dysfunction

by Janet Casperson, BS, MSN, ANP-C

Not only is the future of research and therapies for erectile dysfunction exciting but the potential relationship of erectile dysfunction and cardiovascular disease and risk factors may allow the clinician to save a man's life based upon his erections. It's conceivable that we all may be taking one of these PDE-5 inhibitors in the next decade for prevention and protection from the ravages of aging. By aggressively managing our cardiovascular risk factors, we are aggressively managing our risk factors for erectile dysfunction. By aggressively managing our treatment and optimizing our cardiovascular function, we are optimizing our erections as well.

As we have said all through this Center, the harder the erection, the healthier the man. The future will bring more types of PDE-5 inhibitors that have more optimal durations of action and onset. Medications to stimulate the brain to achieve erections are already in clinical testing. Other advances will be topical medications that are rubbed on the penis and a whole host of treatments for female sexual dysfunction, including topical medication to improve blood flow. Remember, all the same risk factors and risk factor modifications apply to both men and women. Loss of arousal in a woman is nothing more than decreased blood flow to the vagina and genitals which can be remedied with the appropriate therapy.

The future of prevention and treatment of erectile dysfunction and cardiovascular disease is extremely exciting and holds great promise. When we aggressively manage the metabolic syndrome with lifestyle modification and medications, we will see dramatic improvements in erections. Type II diabetes, now at epidemic proportions in the United States, is treatable with exercise, diet and appropriate medications.

The surgical arena for treatment of erectile dysfunction has stabilized. The penile implant is probably the best option we have. The placement of these implants has never been safer and better. The devices have had multiple modifications to prevent the most dreaded complication, infection and the incidence of infection is at an all-time low. The design and function of the implant has stayed essentially the same over time; the penile implant is the least revised implant placed in the human body, much less so than hips, knees, valves and other prostheses.

Another exciting therapy is implantation of penile prosthesis in men who have had prostate surgery for cancer. Breast reconstruction is covered by Medicare but penile implants generally are not covered. There is currently a grassroots movement lobbying for insurance reimbursement for the treatment of erectile dysfunction as a consequence of prostate cancer surgery.

References: See Bibliography

August 2006
Posted August 2008