ABC of sexual health: Erectile dysfunction
Treatment of erectile dysfunction is initiated after taking a patient's history and examination (see previous articles), and possibly investigation.
In highly selected patients with a clear psychological problem, psychotherapy or sex and couple therapy can be used, but these are time consuming and are available to only a small number of patients. Nevertheless, it is essential to treat the whole person and not just his penis. Counselling, alone or separately from sensate focus techniques,1 should be considered as an option. Erectile dysfunction is of a largely psychological nature in a third of patients, in a third it is largely physical, and the remaining third have both physical and psychological factors.
The drug needs to be taken an hour (or 1½ hours after a meal) before sexual activity and does not work unless there is physical or mental sexual stimulation, a fact which needs to be spelled out carefully to some