Erectile dysfunction, twenty years after

We are presenting in this article the third updated version of “Guidelines for non-sexologist general practitioners for first-line treatment” for a patient suffering from erectile dysfunction (ED). This work follows the methodology recommended by the French National Health Authority, and includes an in-depth documentary search of medical and scientific bibliographic data. It was conducted by a working group that identified, selected, analysed and summarised the scientific literature used to prepare these guidelines. All this work was reviewed by a reading group that expressed an opinion on the substance and format of these guidelines, in particular concerning their legibility and ease of application. Amongst the main points that have been updated and which are presented in detail in the articles of this issue, we draw attention in particular to: a change in definitions, abandoning the classification of erectile dysfunction by aetiology, dividing it into three types (organic, psychogenic and mixed), preferring a better suited integrated definition, recognising that these various factors can overlap; the issue of the partner's role in triggering or maintaining the patient's ED is today seen as an important factor that should not be overlooked; the high prevalence of ED has been confirmed by recent studies, as well as its steady rise with age. But the older patients would today appear to be more acutely affected in terms of their quality of life. For younger patients, the prevalence of ED can also be high, linked to lack of activity, comorbidities, or excessive consumption of alcohol and/or toxic substances. Vulnerable populations (patients with comorbidities, diabetes, hypertension and cardiovascular pathologies, depression etc.) are today identified as presenting high levels of risk for high prevalence of ED. ED is often an “indicator” of a comorbidity, in particular for certain conditions such as cardiovascular disease, diabetes, depression, or impaired urination. In such cases, its emotional impact is intensified; treatments have also evolved, with the arrival of new drugs, and better structured care to take account of the various organic, psychological and relationship factors. These guidelines were designed as a support for diagnosis and treatment, for first-line management of patients consulting for erectile dysfunction, and are summarised by an algorithm. We have added a Communication Guide to help practitioners to tackle the issue of sexuality with patients whenever this is helpful or necessary.