title: The Phosphodiasterase 5-Inhibitors (PDE-5i) for Erectile Dysfunction (ED): A Therapeutic Challenge For Psychiatrists.
abstract: Erectile function (EF) is a prerequisite for satisfactory sexual intercourse (SI) and central to male sexual functioning. Satisfactory SI eventually initiates orgasm - a biopsychophysiological state of euphoria - leading to a sense of bliss, enjoyment and positive mental well being. For a psychiatrist, treating ED is self-propelled to harmonize these pleasurable experiences alongside with encouragement of physical wellness and sensuality. Hence, the role of PDE-5i is pivotal in this context and constitutes a therapeutic challenge. PDE-5i work via the dopaminergic-oxytocin-nitric oxide pathway by increasing the availability of endothelial's guanosine monophosphate (GMP), immediately causing relaxation of the penile smooth muscle and an erection. The PDE-5i, like sildenafil, vardenafil and tadalafil, are effective in the treatment of ED with some benefits/ flexibilities and disadvantages compared to other treatment modalities. Prescribed PDE-5i exclusively improve EF, fostering male's self-confidence and self-esteem. Treatment failures are associated with factors such as absent (or insufficient) sexual stimulation, psychosexual conflicts and the co-existence of medical disorders. Managing ED requires dealing with underlying medical diseases, addressing other co-morbid sexual dysfunctions like premature ejaculation (PE), and educating the patient on healthy life-styles. Furthermore, by dealing with interpersonal dynamics within the couple and embracing adequate lifestyles (managing stress and revising one's sexual scripts), PDE-5i treatment benefits may be enhanced. In this review, we propose a holistic conceptual framework approach for psychiatric management of patients with ED.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Chong Siew
authors.initials: CS
authors.lastname: Koon
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Hatta
authors.initials: H
authors.lastname: Sidi
authors.affiliation: Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Jaya
authors.initials: J
authors.lastname: Kumar
authors.affiliation: Hospital Bahagia Ulu Kinta, 31300 Tanjung Rambutan, Perak, Kelantan, Malaysia.
authors.forename: Ong Wan
authors.initials: OW
authors.lastname: Xi
authors.affiliation: Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Srijit
authors.initials: S
authors.lastname: Das
authors.affiliation: Zwirki I Wiguri 62, Medical University of Warsaw, Poland.
authors.forename: Muhammad Hizri
authors.initials: MH
authors.lastname: Hatta
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive New York, New York 10032, United States.
authors.forename: Cesar
authors.initials: C
authors.lastname: Alfonso
mesh_terms: D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011613:Psychotherapy; D019529:Sexuality
chemical_list: D058986:Phosphodiesterase 5 Inhibitors
keywords: Erectile dysfunction; PDE-5 inhibitor; body-mass index; hypertension; psychiatric management of ED; sexual fantasy.