In the diagnosis of erectile dysfunction, it is important to evaluate risk factors (GUK, lipidogram, testosterone, prolactin, BMI, blood pressure). It is necessary to find all those factors or causes that cause or maintain ED and affect them. One of the first measures we advise the person with ED is to increase physical activity (but avoid riding or riding a bicycle), reducing excessive body weight, smoking cessation or drinking alcohol, taking drugs.
With these lifestyle changes, after about three to four months, the first positive effects can be seen.An important factor is reducing anxiety, talking to a partner, for which reason every ED patient should be advised to come to a check with a partner.
The first choice in pharmacotherapy is type 5 phosphodiesterase inhibitors (PDE5i). Four of these drugs are registered with us: sildenafil, avanafil, tadalafil and vardenafil. Among them there are certain differences, for clinical work, an important time to achieve peak concentration, half-life and selectivity for certain types of phosphodiesterase, because the selectivity depends on the side effect profile.
In practical work with patients, it is important to emphasize that the drug works only after 45 minutes (and tadalafil and a little later) because many men expect immediate effect. It is also important to emphasize that these drugs do not act on sexual desire (they allow erection), and that stimulation is needed for their effect (no stimulation will be erections). Also, their effect does not need to be seen after the first application and requires up to six separate attempts to see the true effect of the drug so it is completely wrong to declare the drug ineffective after the man has twice taken this drug and had no firm erection.