Title:The Phosphodiasterase 5-Inhibitors (PDE-5i) for Erectile Dysfunction (ED): A Therapeutic Challenge For Psychiatrists
Volume: 19
Issue: 12
Author(s): Chong Siew Koon, Hatta Sidi*, Jaya Kumar, Ong Wan Xi, Srijit Das, Muhammad Hizri Hatta and Cesar Alfonso
Affiliation:
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur,Malaysia
Keywords:
Erectile dysfunction, PDE-5 inhibitor, psychiatric management of ED, body-mass index, hypertension, sexual fantasy.
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.
