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JAOA • Vol 104 • No 3_suppl • March 2004 • 1-
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EDITORIAL

Erectile Dysfunction: A Return to Sexual Activity and Intimacy

Leonard H. Finkelstein, DO

Dr Finkelstein is vice chancellor and professor of surgery, Philadelphia College of Osteopathic Medicine.

Address correspondence to Leonard H. Finkelstein, DO, FACOS, Philadelphia College of Osteopathic Medicine, 4190 City Ave, Philadelphia, PA 19131-1610. E-mail: Finkel123{at}aol.com

More than 50% of men between the ages of 40 and 70 years have some degree of erectile dysfunction. With many millions of men worldwide having this problem, it is not surprising that we are seeing more and more articles relating to this condition. Considering that our knowledge of the physiology and pathophysiology of and therapy for erectile dysfunction are expanding almost on a daily basis, this proliferation of articles is certainly appropriate.

Only in the past year, we have seen two additional phosphodiesterase type 5 (PDE5) inhibitors, vardenafil hydrochloride and tadalafil, that will share the therapeutic spectrum with the original breakthrough agent sildenafil citrate. With each of these drugs having unique characteristics, it is important that we know which agent would be most appropriate when treating our patients. It appears that one major benefit of the new PDE5 agents will be an increase in flexibility of sexual activity.

The articles by David O. Sussman, DO, and Margaret R. H. Nusbaum, DO, MPH, in this J A O A supplement discuss in detail the efficacy, safety, and pharmacology of the PDE5 agents. These authors also mention additional benefits of the new PDE5 inhibitors for patients with comorbid conditions such as coronary artery disease.

Unfortunately, since the advent of sildenafil, many physicians have moved some areas of the management of erectile dysfunction to the back burner. In these days of managed care, it is too easy to say to a patient, "Give me your symptom, and I will prescribe a pill." Such an approach runs counter to our osteopathic philosophy and principle of treating the patient, not just the symptoms. A thorough history and physical examination with the inclusion of an interview with the sexual partner are just some areas that should be included. The article by Marian E. Dunn, PhD, provides a psychological perspective and discusses these aspects in detail.

This supplement again emphasizes the ever-increasing important role of the primary care physician in the management of erectile dysfunction.





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