Defined as the inability to achieve or maintain an erection that is sufficient to ensure satisfactory sex for both partners,² ED is a common problem that affects more than 150 million men worldwide, with the number expected to double by 2025.¹

While almost all men have trouble getting or keeping an erection at one time or another, for some it can be an ongoing problem. Fortunately, with the development of effective drugs to treat ED, there is no reason for couples to suffer. Crediting oral phosphodiesterase inhibitors as having changed the management of ED, Yafi et al. describe first line therapy as having created a sexual revolution.²

KEY TO SUCCESSFUL TREATMENT

Highlighting the need to treat the couple as a unit Dr Kgomotso Mathabe, a specialist Urologist practicing at Steve Biko Academic Hospital said that to achieve success when initiating first line management with oral phosphodiesterase type 5 (PDE5) inhibitors it’s important to manage patients’ and couples’ expectations, this is what makes it preferable to see couples together.

Two treatment features that are particularly important are early treatment success, and then continued treatment success. “But this is very subjective and highly individualised,” Dr Mathabe explained. “For one couple this is if they are able to have sex once during the week, or once during the month, so we need to discuss this with them at the beginning – what was normal for them, and what the goal is that they would like to achieve – so that we’re managing expectations and not applying a blanket approach to everybody.”

IMPACT OF ED ON THE COUPLE

According to Li et al. ED has detrimental social and psychological effects on the quality of life of both affected individuals and their sexual partners. Echoing Dr Mathabe’s sentiments they believe that when medical intervention is introduced to treat ED, healthcare professionals should consider the disorder as a shared health problem for the men with ED and their sexual partners.¹

Reviewing several studies Li et al. found that partners were often aware of the problem, or at least acknowledged the problem, before the patients. They also found that while many ED studies have focused on the patients’ point of view, the effects of ED on the partners are strikingly similar to the effects on the patients. Some interesting findings included:

• Females with a partner with ED develop a sexual dysfunction disorder exclusively triggered by partner’s ED. If the partner is aware of this, then they are better prepared if this happens.
• ED has negative effect on the quality of sex life for both partners in a relationship.
• ED has resulted in reduced intimacy (including caressing, kissing, touching, and foreplay).

PDE5 inhibitors: What are the options?

Currently, three phosphodiesterase type 5 (PDE5) inhibitors are available for clinical use in SA; sildenafil, vardenafil, and tadalafil.³ Multiple studies have shown that all three drugs are highly effective. The main difference is in how long they are effective for. Dr Mathabe explains that while sildenafil (25-100mg) and vardenafil (5-20mg) are effective in the short term (up to 4-8 hours – effective 30min after taking), tadalafil (20mg) is effective in the long term (up to 36 hours – effective 30min after taking).⁴

So, it depends on what suits the patient’s lifestyle and needs. For example, if they’re only planning to have sex once a week and they know exactly when it will be, and they only want to take a pill when they have sex then any one of the three PDE5 inhibitors would work. But if their sex life is more spontaneous, and the idea of taking a tablet once a day appeals to them, then they want to consider tadalafil.

Li et al. believe that a sexual partner-engaged approach to ED might assist treatment and rehabilitation, helping the couples affected by ED to achieve a high-quality sex life.

REFERENCES

1. Li H, Gao T, Wang R. The role of the sexual partner in managing erectile dysfunction. Nat Rev Urol. 2016 Mar;13(3):168-77. doi: 10.1038/nrurol.2015.315. Epub 2016 Feb 2. PMID: 26832165.
2. Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, Maggi M, Nelson CJ, Parish S, Salonia A, Tan R, Mulhall JP, Hellstrom WJ. Erectile dysfunction. Nat Rev Dis Primers. 2016 Feb 4;2:16003. doi: 10.1038/nrdp.2016.3. PMID: 27188339; PMCID: PMC5027992.
3. N Schellack (Senior Lecturer) & A Agoro (2014) A review of phosphodiesterase type 5 inhibitors, South African Family Practice, 56:2, 96-101, DOI: 10.1080/20786204.2014.10855345
4. Evans, Jeffery D, and Stephen R Hill. “A comparison of the available phosphodiesterase-5 inhibitors in the treatment of erectile dysfunction: a focus on avanafil.” Patient preference and adherence vol. 9 1159-64. 12 Aug. 2015, doi:10.2147/PPA.S56002