AB63. Controversial issues in erectile dysfunction

Erectile dysfunction (ED) is a prevalent medical condition. With the advent of phosphodiesterase type 5 (PDE-5) inhibitors, the treatment of ED has been revolutionized during the last two decades. Although there are great advances in the diagnosis and treatment of ED, there are two common controversial issues in our practice that merit further discussion. First, psychogenic or organic ED? ED is traditionally classified as organic and psychogenic based on the etiology. Many problems arise with this distinction. Psychogenic ED is a misnomer because it is based on an obsolete view of mind-body distinctions, ignores the manifestations of neurobiology of psychological disorders and the fundamental meaning of psychosomatic result, is too often diagnosed by exclusion and may indicate that ED all result from mind problem. All ED of organic origin therefore also has a psychogenic aspect. Every patient whose ED is mainly due to an organic disorder builds his own world of fear, anxiety, worry, depression, and distress around his disorder. The distinction between psychogenic and organic ED has become counterproductive in the diagnosis, classification and treatment of ED. This distinction should be abandoned, not just from the taxonomy of ED, but also from systematic thinking about the causes of erection and its disorders. Second, is it possible to “ED” with oral pharmacotherapy? Clinical and basic science have provided convincing evidence that ED is predominately a disease of vascular etiology correlating with diabetes mellitus, hypertension, atherosclerosis, hyperlipidemia, smoking, and obesity. Chronic administration of PDE-5 inhibitors has reportedly been associated with increased persistent vascular and endothelial function. Clinical studies have revealed a potential protective role of these compounds on endothelial function in short- and long-term assessments. Data available from animal models also support the evidence of potential benefits induced on endothelial function. However, these studies were limited by small case numbers, short-term follow-up. Evidence to support the reversal of ED by chronic administration of a PDE5 inhibitor is still lacking. An improvement of endothelial function is not equivalent to recovery of erectile function. The downside of continuing to promote the precept of chronic dosing as a cure for ED might result in the emotional and financial cost to our patients, the disillusionment by our referring colleagues, and the loss of our scientific credibility.