Breaking the silence: helping men with erectile dysfunction

CARE OFTHE OLDER PERSON
(Engender Health, 2003), and the stigma associated with
erectile dysfunction can cause the man to withdraw from
intimacy. In some cases all forms of physical contact can
become non-existent, resulting in emotional distress, causing
stress and adding to the psychogenic component associated
with erectile dysfunction. Treatment has the potential
to resolve depression and improve the man's self esteem and
overall quality of life and sense of weDbeing (Carson and
McMahon, 2008).
Currently, practitioners working in the primary care
setting implement the guidance issued by the Department
of Health (DH), in a number of Health Service Circulars
(DH, 1999a; 1999b; 1999c), to determine the management
and treatment of men with erectile dysfiinction.The circulars
provide the community nurse with guidance on good
practice for those men who qualify for treatment within
the NHS. Further guidelines have heen produced hy the
BSSM (2008); this guidance, while still adhering to the
current DH circulars, is underpinned hy a more up-to-date
evidence base.
Regardless of the treatment plan chosen, the nurse has
a duty to provide the man and (if appropriate) his partner
with appropriate and adequate informadon to help
him understand the reasons why erectile dysfiinction has
occurred. Explaining to the man how his problem compares
with the general population may help him feel less
stigmatised, and debunking any myths associated with
erectile dysfunction can provide an opportunity for him
and his partner to understand each other's sexual needs and
their sexuality and to chose the most appropriate treatment.
There are a number of treatment options available for
erectile dysfunction, and inany of these have been developed
and revised over time, becoming more effective.
Carson and McMahon (2008) consider treatment options
from psychogenic and organic perspectives. The choice of
treatment will depend on several factors, such as patient
(and, if appropriate, partner) preference, severity of erectile
dysfunction and the underlying cause. Rané and Fraser
(2007) recommend a 'step ladder' approach to treatment,
progressing from non-invasive talking therapies and drug
therapies, to minimally invasive injection therapy {Figure 3)
and vacuum devices, to invasive prosthetic surgery. Table 4
provides an overview of treatment options.
In order to help the patient chose the right treatment
option, the nurse must have an up-to-date and in-depth
knowledge base. Not all treatment opdons will suit all men,
and they all have side-effects and contraindications. There
is no 'one size fits all' approach: each man must be assessed
and treated as an individual. The information and advice
that the nurse offers should he provided in such a way that
the man understands the options, the advantages and drawhacks,
with the intention of making an informed choice.
Conclusion
Erectile dysfunction can have devastating effects on individuals.
Men report feelings of guilt and shame, and experience
stigma associated with this condition that can lower
self esteem and impact negatively on the person's sense of
wellbeing. Community nurses are ideally placed to help
men and, if appropriate, their partner(s) to come to terms
with the condition and to select the most appropriate
treatment option. In order to provide this information it
is essential that the nurse is knowledgeable and up-to-date
with contemporary approaches to the care and management
of men with erectile dysfunction.
BJCN
Acknowledgements: I would like to thank Mrs Frances Cohen for
her help and support.
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LEARNING POINTS
• Sex is an important aspect of many people's lives
• Our understanding of erectile dysfunction continues to develop
• The community nurse is ideally placed to help men (and their partners)
who experience the physical and psychological impact erectile
dysfunction can have on their lives and wellbeing
• Any condition that damages endothelial function can result in erectile
dysfunction
• Some men with erectile dysfunction will also have coexisting conditions
such as hypertension, hyperlipidaemia, diabetes and depression
British Journal of Community Nursing Vol 17, No 7 317