Comparison of Phosphodiesterase Type 5 (PDE5) Inhibitors

P. J. Wright


Int J Clin Pract. 2006;60(8):967-975. 

In This Article

Treatment of Erectile Dysfunction

The goals of ED treatment are to restore QOL and allow the patient to have a sex life equivalent to that which they had before. To allow more natural intercourse, some patients might also wish to have a treatment that has a long period of responsiveness, so that they feel less pressure to perform within a designated time.

In a study of 110 men with ED and obesity, lifestyle changes have been shown to improve sexual function in approximately 30% of men.[10] Although the authors commented that contact with the patients was intensive and so the results may not be wholly applicable to primary care populations, both weight loss and increased physical activity were independently related to an improvement in ED. However, as treatment of underlying organic risk factors does not always improve erectile function significantly,[5] it is often necessary to treat the ED itself.

Available treatment options for ED include oral therapies, surgical treatment, injections and mechanical devices. However, as most men prefer less invasive treatments, oral treatments are generally the first choice. Consequently, since the introduction of the very effective PDE5 inhibitors, other treatment options are being used less frequently.

Oral treatments are noninvasive, easily administered, effective and well tolerated. For these reasons, the World Health Organization recommends that oral therapies are used as the first-line treatment of ED.[4] Oral treatment with the centrally acting sublingual apomorphine is available but the most effective treatments are the PDE5 inhibitors.[11] These agents have not only improved the management of ED over the last 6 years but have also increased patient expectations for a successful outcome.[12] Sildenafil was the first PDE5 inhibitor licensed for use in ED. Since then, a new generation of PDE5 inhibitors, each with their own range of characteristics, have achieved product licences.


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