Therapeutic strategies for managing erectile dysfunction: a step-care approach

During the past two decades, advances in the understanding of erectile dysfunction have provided primary care physicians, urologists, and other healthcare providers with additional treatment options. The introduction of sildenafil citrate, the first oral phosphodiesterase type 5 (PDE5) isoenzyme inhibitor, has helped to restore erectile function and improve overall health and quality of life. The step-care approach to the treatment of erectile dysfunction can be divided into first-, second-, and third-line modes of therapy. Most patients with erectile dysfunction will choose oral agents because of their simplicity and ease of administration. This article reviews all treatment strategies for erectile dysfunction, with a focus on PDE5 inhibitors, including novel agents that may optimize patient outcomes.