What exactly are we trying to cure when we treat someone for erectile dysfunction?

SummaryRepresentations of erectile dysfunction, the patient's expectations, the treatment prescribed, and what is considered to be a “cure” will all depend on whether one is the patient, his partner, a referring GP, a sexologist or a “shrink”. One might well challenge the validity of a treatment that only takes account of the symptom “erectile dysfunction”, without concern for its impact on the subject's quality of life and any possible complications and consequences it might have.ObjectivesThe objectives of this article are to try to provide answers to the following questions: by what means can a cure be found, what methods are used, and what are the most meaningful criteria to use in follow-up.MethodWe conducted a review of literature over the past 15 years using Medline, on the basis of the following keywords: erectile dysfunction, sexual response, impotence, sexual relationships and sexual satisfaction.DiscussionThere are numerous articles dealing with these subjects, particularly concerning the use of PDE5 inhibitors. Studies show that when treatment is effective, once the erectile dysfunction is “cured”, the personal relationship improves, as does self-esteem and self-confidence, which reaches comparable levels to that of patients without sexual dysfunctions. But sometimes, additional therapy is necessary alongside the treatment by medication. An improvement in sexual dysfunction or a cure will depend of course on its severity, but also on any comorbidities and their interrelations with the erectile dysfunction itself.One should systematically think of somatic complications, and investigate any organic risk factors such as urological, cardiovascular, metabolic and hormone risk factors, but also possible abuse of psychoactive substances including alcohol, smoking and some of the illegal drugs. Possible psychological factors should also be investigated, such as reactions to psychological or social stress, which are often evidenced. Consequently, the concept of cure will also require an improvement in the psychological symptoms, either those that have appeared since the erective dysfunction, or which were the cause of it. Finally, the erectile dysfunction can bring about marital conflict and the follow-up of the erectile dysfunction should take account of how this has evolved, or even attempt to resolve these conflicts.ConclusionThe data to be found in literature show that curing an erectile dysfunction means restoring a better quality of life in general and in all its various aspects, in particular physical and mental health, loving and marital relationships, as well as social relations. These objectives are more ambitious but more important for the quality of life of the patients than regaining sexual satisfaction or penile rigidity. The idea of a cure is therefore reliant on a global therapeutic approach.