JLE

Médecine de la Reproduction

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The clinical approach of erectile dysfunction is still, and more than ever, necessary Volume 13, supplement 1, Décembre 2011

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Centre hospitalier Chambéry, Service d’urologie-andrologie, square Massalaz, 73011 Chambéry, France

Despite the efficacy of the pharmacological treatment, the clinical step and its management are, more than before, a key for the treatment of erectile dysfunction (ED), new clinical marker of non sexual health. Its positive, etiological and differential diagnosis, its complexity, its prognosis, its management and its treatment are above all clinical, lying on both subjective history data and objective physical examination data. The paraclinical and complementary opinions are almost exclusively conditioned by age and clinical check-up. At present, this clinical approach is as important as ED reflects a deficiency of both health state (always) and quality of life (often) requiring a general practitioner-like global health check-up. Presently, the evaluation of non sexual health (mainly cardiovascular) is a major clinical time: a) good medical practice recommends a most precise etiological diagnosis (often multifactor) for better optimizing the etiological treatment(s) and for curing the symptom and its cause; b) ED may be the revealing symptom or the impairment marker for several major chronic diseases and/or health risk situations that can engage more or less rapidly the vital prognosis. This paradigm change explains the current recommendations (grade A) of a systematic clinical check-up of both somatic (cardiovascular first) and psychological health in the same way that sexual health and patient's quality of life. Thus, to prescribe an oral drug without evaluation and explanation is a mistake, as any ED must benefit from a global approach, i.e. directed by the clinical data and adapted to each patient according to his demands, sexual life reality and sexual “ecology”.