Introduction

INTRODUCTION Treating Erectile Dysfunction: Improving Communication and Maximizing Outcomes Andrew R. McCullough, MD, FACS Department of Urology, New York University School of Medicine, New York, NY [Rev Urol. 2003;5(suppl 7):S1-S2] © 2003 MedReviews, LLC edical school is only the beginning of the education of physicians. The education process is lifelong, requiring a commitment on the part of the physician to maintain and hone his or her clinical skills. Whereas the primary treatment of male sexual dysfunction in the 20th century was by provided by urologists, in the 21st century, treatment is provided primarily by non-urologist physicians. More than 85% of prescriptions for phosphodiesterase-5 inhibitors are initially written by non-urologist physicians (family practitioners, internists, nurse practitioners, cardiologists, and endocrinologists). However, many of these physicians have had no formal training in the field of sexual medicine, and medical schools, by and large, do not incorporate this field into their curricula. With public knowledge about erectile dysfunction (ED) increasing, physicians are being challenged in areas with which they may not be familiar or comfortable. Patients are asking not only about ED but also about libido issues, ejaculatory dysfunction, and orgasmic dysfunction, as well as the highly complex field of female sexual dysfunction. Indeed, physicians have, by default, become sex therapists. Another interesting evolution in the area of sexual medicine is an increasing dialogue among specialists. Urologists, cardiologists, endocrinologists, and mental health professionals are combining their knowledge and expertise to improve the understanding of this multidimensional field of medicine. Although patients are increasingly asking about sexual issues, they remain reluctant and embarrassed to do so. In addition, physicians, with their increasingly busy schedules and unfamiliarity with sexual medicine, do not perceive the importance of this line of inquiry. There is a pressing need for constant education and re-education in this rapidly evolving field. M VOL. 5 SUPPL. 7 2003 REVIEWS IN UROLOGY S1 Introduction continued It is beyond the scope of this supplement to cover all aspects of male sexual dysfunction. We do, however, tackle some of the challenges of ED treatment, combining the efforts of opinion leaders in the fields of urology, cardiology, and family practice. Whereas, in the past, ED was considered a quality-of-life issue, it is now S2 VOL. 5 SUPPL. 7 2003 known that the condition is a sentinel symptom of underlying cardiovascular disease. This supplement is focused on practical issues in the management of ED: • The pathophysiologic relationship between ED and endothelial dysfunction REVIEWS IN UROLOGY • Penile dysfunction as a sentinel marker for the presence and severity of endothelial dysfunction • Ways to facilitate the professional dialogue with patients about sexual issues • Optimizing outcomes for oral therapy • Recent advances in oral therapeutics for ED