PDE5 Inhibitors
I appreciate this article as it is co-authored by a sex therapist and a urologist who have differing thoughts on PDE5 inhibitors. Both acknowledge that all drugs, including these drugs, have side effect profiles worth considering before taking them for the long term.
The American Urological Association defines erectile dysfunction (ED) “as an impairment in the arousal phase of sexual response and is defined as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.” Phrases that I typically hear are “can’t get it up,” “won’t stay hard,” or “too soft for penetration.” PDE5 inhibitors are oral treatments for ED, such as sildenafil (Viagra, Revatio), vardenafil (Levitra and Staxyn), tadalafil (Adcirca and Cialis) and avanafil (Stendra).
As a sex therapist, I would want to explore what the definition of a satisfactory sexual experience is to each individual, but no one asked for my opinion.
A client’s struggle to maintain an erection can be physiological and/or psychological, so taking a PDE5 inhibitor in conjunction with sex therapy will likely lead to optimal outcomes. Here is a non-exhaustive list of physical conditions that might lead to ED:
Diabetes
High blood pressure
Low T
Medication side effects
Substance use like alcohol, amphetamines and opiates
A client should talk to their provider about ED in the context of a medical appointment, not as a statement when they’re walking out the door. (Providers love a “door knob” statement. *sarcasm ) Most prescribers are willing to prescribe a PDE5 inhibitor. They went into medicine to help people, not to be gatekeepers.
Here is a non-exhaustive list of psychological health conditions that might lead to ED:
Anxiety and stress are an erection’s enemies. Anxiety about not getting it up creates a vicious cycle of continuing to not get it up.
Expectations are too high. Whether it’s from pornography or somewhere else, we need to right-size our expectations. Sometimes that takes working with a sex therapist.
Dissatisfaction within a relationship. No amount of medicine is going to fix relationship conflicts or increase arousal.
Mood disorders. Seeking pharmaceutical and therapeutic support can treat depression quite quickly.
Like all medications, PDE5 inhibitors have their place. It’s important to talk with your provider about the risks and benefits and perhaps talk to a sex therapist about expectations, rewriting sexual scripts, or to address concerns within your relationship.
Klein, Marty R., & Shindel, Alan W. (2023). Prescribing PDE5 Inhibitors: Best Practices, Common Practices and Controversies. Current Sexual Health Reports. https://doi.org/10.1007/s11930-023-00367-w
