Do not prescribe phosphodiesterase-5 inhibitors (PDE5i) in men with erectile dysfunction (ED) without an adequate diagnostic work-up.

Type of practice




Prescribing PDE5i without performing an appropriate diagnostic work-up to detect the ED-associated morbidities represents a missed opportunity. In fact, in ED patients the stratification of cardiovascular risk is simple, non-invasive and can reveal an asymptomatic condition, allowing a great opportunity for secondary prevention.Even in patients with psychogenic ED there is no indication to suggest PDE5i without performing a first-level diagnostic work-up: thus. In this setting, the inconstant PDE5i use can lead to a decreased confidence in the spontaneous capacity of erection and to a sort of pharmacological addiction, worsening performance anxiety and, eventually supporting the vicious circle at the basis of the disorder.


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2. Foresta C, Ferlin A, Lenzi A, Montorsi P and Italian Study Group on Cardiometabolic Andrology. The great opportunity of the andrological patient: cardiovascular and metabolic risk assessment and prevention. Andrology 2017; 5: 408-413.
3. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FC. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012; 87: 766-78.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.