title: Erectile dysfunction - when tablets don't work.
abstract: BACKGROUND
  Erectile dysfunction (ED) is a common clinical problem managed in the general practice setting. While the majority of men will find phosphodiesterase-5 (PDE-5) inhibitors effective, there is a subgroup of men who require second and third line therapies.
  
  
  OBJECTIVE
  This article provides an overview of ED and its management with particular focus on the group of patients in whom oral agents fail.
  
  
  CONCLUSIONS
  Erectile dysfunction is a multifactorial condition that affects approximately 40% of Australian men. The incidence of ED is age related however, it shares common risk factors with cardiovascular disease and metabolic disorders. The management of ED should begin with an assessment of cardiovascular risk factors, advice on lifestyle modification, and a trial of PDE-5 inhibitors. Second line therapies include intracavernosal injections and vacuum erection devices, while third line therapy entails penile implants. Factors that influence treatment success include partner inclusion, good patient selection, as well as ongoing support and education.
authors.affiliation: Liverpool Hospital, Sydney, and Faculty of Medicine, University of Western Sydney and University of New South Wales, Australia. ianandvanessa@live.com.au
authors.forename: Ian A R
authors.initials: IA
authors.lastname: Smith
authors.forename: Nicholas
authors.initials: N
authors.lastname: McLeod
authors.forename: Prem
authors.initials: P
authors.lastname: Rashid
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001315:Australia / Q000453:epidemiology; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D015917:Penile Prosthesis; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D013739:Testosterone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D013739:Testosterone