Oral Medications for Erectile Dysfunction: Mode of Action and Treatment Issues.
Richard Casey, The Male Health Centres, Oakville, Ontario.

This paper describes the physiological processes involved in penile erection and uses this information to explain the mode of action of oral medications used in the treatment of erectile dysfunction (ED). New biomedical treatments for ED, such as sildenafil, present both a challenge and an opportunity for health care professionals to address ED with their patients and clients. An algorithm for the treatment of ED by primary care physicians is proposed and discussed in relation to diagnosis, outcome measurement, referral, and use of sildenafil and other treatment options.  (The Canadian Journal of Human Sexuality, 1998; 7: 203-212)

Integrating New Biomedical Treatments into the Assessment and
Management of Erectile Dysfunction.
Rosemary Basson, Department of Psychiatry and Department of Obstetrics and Gynecology, University of British Columbia.

There is a growing awareness and use of effective biomedical treatments for erectile dysfunction (ED). Although often originating partly from pathophysiological factors, ED has interpersonal and psychosocial implications for men and their partners. This paper draws attention to the need for clinicians to address the affective and cognitive factors that can be both causes and consequences of ED. A review of the treatment outcome literature supports the need for an integrated approach to the treatment of ED that employs biomedical treatments in the context of overall sexual health and interpersonal relationships.  (The Canadian Journal of Human Sexuality, 1998; 7: 213-230)

Erectile Dysfunction: A Review of Current Medical Treatments.
Eli Coleman, Program in Human Sexuality, University of Minnesota Medical School.

Erectile dysfunction (ED) affects large numbers of men, particularly those over the age of 40. As a result, health care providers who address ED in their work should be familiar with the range of treatment options available. This paper reviews the scientific literature on currently available medical treatments of ED: penile implants; vascular surgery; intracavernosal injections; vacuum erection devices; penile support sleeve; intraurethral suppositories; and oral/topical treatments.
The effectiveness, advantages and disadvantages of each method are examined. It is recommended that health care providers and their patients with ED begin by exploring the least invasive treatments and consider the more invasive treatment options only if necessary.
(The Canadian Journal of Human Sexuality, 1998; 7: 231-244)

Psychosexual and Psychosocial Aspects of Male Aging and Sexual Health.
Michael Metz, Meta Associates, St. Paul, Minnesota and Michael Miner, University of Minnesota Medical School.

This paper examines the male aging process in the context of the biological and psychosocial dimensions of male sexual health. The scientific literature concerning the physiological and psychosocial aspects of male aging, and the impact of aging on male sexual function and sexuality is summarized and discussed. A biopsychosocial model for conceptualizing the interaction between the various aspects of the aging process is proposed as a means of assisting men in adapting to their changing sexuality in a positive way. The importance of distinguishing between the normal changes in sexual function and response associated with aging and those changes associated with specific health problems is emphasized.  (The Canadian Journal of Human Sexuality, 1998; 7: 245-260)

Addressing the Sexual Health Needs of Gay and Bisexual Men in Health Care Settings
Brian M. Cornelson, Family and Community Medicine, Wellesley-St. Michael's Hospital, Toronto, Ontario.

This paper identifies key issues that health professionals must address in order to provide appropriate health care services to gay and bisexual men. It focuses on sexual health matters that are particularly pertinent when working with men who have sex with men. These include: the importance of gay- and bisexual-positive language and terminology;  the use of discretion in applying labels to men who have sex with men; a man's self-acceptance as gay or bisexual; the coming out process; internalized homophobia; attitudes and insights on bisexuality; relationship issues of gay couples; HIV/AIDS; HIV infection and sexual health; other STDs; fertility issues for gay and bisexual men; and access to discrimination-free health care. Health care providers who are knowledgeable about these issues will be better able to provide sensitive and informed health care services to gay and bisexual men.  (The Canadian Journal of Human Sexuality, 1998; 7: 261-270)

The Physician's Role in Dealing with Men's Sexual Health Concerns
Stephen Holzapfel, Department of Family and Community Medicine, University of  Toronto, and Sexual Medicine Counselling Unit, Women's College Hospital, Toronto, Ontario.

Although sexual health concerns are common in men of all ages, many men are reluctant to bring up sexual health issues with their physicians, and many physicians do not routinely inquire about these important aspects of their patient's health and well-being. This paper suggests ways physicians can effectively manage male sexual health problems with particular emphasis on low sexual desire, rapid ejaculation, delayed ejaculation, and erectile difficulties. It describes an integrated approach that incorporates medical, psychological, and couple factors. Case studies involving heterosexual couples in which the male partner presented with a sexual dysfunction are outlined.  (The Canadian Journal of Human Sexuality, 1998; 7: 273-286)

Sexual Effects of Medications and their Interaction: Implications for Men with Physical Disabilities or Chronic Illness
Jerzy B. Gajewski, Department of Urology, Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia.

A significant number of patients who present for treatment of erectile dysfunction also have coexisting medical conditions.  This paper summarizes common medical conditions and medications that can contribute to erectile difficulties.  The association between chronic illnesses such as cardiovascular disease, diabetes mellitus, renal and liver failure, genital and other cancers, and erectile dysfunction is described.  The effects of medications that act as central and peripheral initiation blockers, and central and peripheral conditioners blockers are discussed in relation to their potential effects on erectile function.  (The Canadian Journal of Human Sexuality, 1998; 7: 287-294)

The Relationship between Fertility Issues and Sexual Problems in Men
Stacy Elliot, The Vancouver Sperm Retrieval Clinic, Vancouver, British Columbia.

About 12% of couples of childbearing age are unable to conceive, and it is estimated that for between 30% and 50% of these couples, it is a male factor infertility problem that prevents conception.  This paper employs bio-physiological and psychosocial perspectives to explore the complex relationship between male sexuality and male factor infertility. Sexual dysfunction can be both a contributing factor to fertility problems and a by-product of the diagnosis of male infertility itself. The physiology of male factor infertility is summarized and the psychosocial aspects of male infertility are examined with particular emphasis on the links between fertility, and masculinity, virility and ejaculatory/erectile function. It is suggested that health care providers can more effectively address the needs of couples with male factor infertility by taking a sexual history as part of an initial infertility assessment, and by encouraging couples to temporarily view sexual functioning and the quest for pregnancy as separate issues.  (The Canadian Journal of Human Sexuality, 1998; 7: 295-303)