Erectile dysfunction (ED) is defined as the inability to achieve and maintain a penile erection adequate for satisfactory sexual intercourse1.

Erectile dysfunction affects the quality of life for both patients and partners and is associated with relationship difficulties.

ED is a common disorder in men, affecting up to 52% of men between the age of 40 and 70 years.2

Beside aging, diabetes is the most common risk factor for erectile dysfunction, which is reported to occur in 35-90% of men affected by diabetes worldwide.3

ED and coronary artery disease share the same risk factors

The incidence of erectile dysfunction increases with age.2

Erectile dysfunction affects the quality of life for both patients and partners and is associated with relationship difficulties.2


  • Antihypertensives: methyldopa, clonidine, reserpine, beta-blockers, guanethidine, and verapamil
  • Diuretics: thiazides and spironolactone
  • Cardiac/circulatory: clofibrate, gemfibrozil, and digoxin
  • Tranquilisers: phenothiazines and butyrophenones
  • Anticholinergics: disopyramide and anticonvulsants
  • Antidepressants: tricyclic antidepressants, MAOIs, lithium, and SSRIs
  • Hormones: oestrogens/progesterone, corticosteroids, cyproterone, acetate, 5-alpha reductase inhibitors, and LHRH agonists
  • H2agonists: cimetidine and ranitidine
  • Cytotoxic agents: cyclophosphamide, methotrexate, and Roferon-A4


In SA, three potent selective PDE5Is have been approved for the treatment of ED, namely Tadalafil, Sildenafil, and Vardenafil.5

ED shares risk factors with cardiovascular disease.6 The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac patient until proven otherwise.7

  1. Muneer A, Kalsi J, Nazareth I, Arya M. Erectile dysfunction BMJ 2014; 348 :g129 doi:10.1136/bmj.g129.
  2. Frajese GV, Pozzi F, Frajese G. Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence. Clin Interv Aging. 2006;1(4):439-49. doi: 10.2147/ciia.2006.1.4.439. PMID: 18046921; PMCID: PMC2699638.
  3. Maiorino MI, Bellastella G, Della Volpe E, Casciano O, Scappaticcio L, Cirillo P, Giugliano D, Esposito K. Erectile dysfunction in young men with type 1 diabetes. Int J Impot Res. 2017 Jan;29(1):17-22. doi: 10.1038/ijir.2016.38. Epub 2016 Sep 22. PMID: 27654032.
  4. Hackett G, Kirby M, Wylie K, Heald A, Ossei-Gerning N, Edwards D, Muneer A. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men-2017. J Sex Med. 2018 Apr;15(4):430-457. doi: 10.1016/j.jsxm.2018.01.023. Epub 2018 Mar 14. PMID: 29550461.
  5. N Schellack (Senior Lecturer) & A Agoro (2014) A review of phosphodiesterase type 5 inhibitors, South African Family Practice, 56:2, 96-101, DOI: 10.1080/20786204.2014.10855345,the%20treatment%20of%20pulmonary%20hypertension
  6. Ramlachan P, Campbell M M. Male sexual dysfunction. SAMJ, S. Afr. med. j.[Internet]. 2014  June [cited 2022  July  04] ;  104( 6 ): 446-447. Available from:
  7. Jackson G, Rosen RC, Kloner RA, Kostis JB. The second Princeton consensus on sexual dysfunction and cardiac risk: New guidelines for sexual medicine. J Sex Med 2006;3(1):28-36