The phosphodiasterase 5-inhibitors (PDE-5i) for erectile dysfunction (ED): A therapeutic challenge for psychiatrists

Chong Siew Koon, Hatta Sidi*, Jaya Kumar, Ong Wan Xi, Srijit Das, Muhammad Hizri Hatta, Cesar Alfonso

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

5 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1366-1377
Number of pages12
JournalCurrent Drug Targets
Volume19
Issue number12
DOIs
Publication statusPublished - 2018
Externally publishedYes

Keywords

  • Body-mass index
  • Erectile dysfunction
  • Hypertension
  • PDE-5 inhibitor
  • Psychiatric management of ED
  • Sexual fantasy

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology
  • Drug Discovery
  • Clinical Biochemistry

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