The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction

Introduction: Erectile dysfunction (ED) is a common condition the treatment of which over the years has
expanded from specialty care settings to various other clinical settings. A Process of Care Model was developed in
1999 to provide primary care physicians with guidance in the diagnosis and management of ED.
Aim: This update to the Process of Care Model aims to reflect current ED management practices, because the
study of ED has changed since 1999.
Methods: Updates to the Process of Care Model were developed during a meeting of international experts from
diverse disciplines. The updated model is data-driven, evidence-based, and relevant to a wide range of healthcare
providers.
Main Outcome Measures: This article summarizes the results of the expert meeting and focuses on ED
management. The evaluation of ED is discussed in a separate article.
Results: The updated model presents modification of risk factors and correction of comorbidities frequently
associated with ED as critical parts of patient management. Patients should be encouraged to make positive
lifestyle changes such as improving diet and increasing physical exercise. Lifestyle changes may be accompanied
by the first-line medical therapies of sexual counseling and therapy, which takes into consideration patient sexual
dynamics and pharmacotherapy with phosphodiesterase 5 inhibitors (PDE5Is).
Clinical Implications: The updated model provides guidance regarding risk factors associated with ED, their
modification, sexual counseling, and PDE5I selection, dosing, and patient education.
Strengths and Limitations: This update leverages the extensive clinical expertise and experience of the authors
to provide updated, comprehensive guidance for ED management. The model reflects the views and experiences
of a limited number of contributors; however, these authors draw upon a diverse array of clinical specialties and
are regarded as experts in their fields. Additionally, no meta-analyses were performed to further support the ED
evaluation guidelines presented.
Conclusion: Effective management of ED may be achieved through a combination of patient risk factor
modification and first-line therapy, taking into consideration any patient comorbidities known to be associated
with ED. Treatment goals should be individualized to restore sexual satisfaction to the patient and/or couple and
improve quality of life based on the patient’s expressed needs and desires. Mulhall JP, Giraldi A, Hackett G,
et al. The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction. J Sex Med
2018;XX:XXXeXXX.
Copyright 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Erectile Dysfunction; Diabetes; Cardiovascular Disease; Depression; Hypertension