Prescribing PDE5 Inhibitors: Best Practices, Common Practices, and Controversies

Erectile dysfunction (ED) is an increasingly common concern that has been a topic of interest to men (and their partners) since time immemorial. In the year 2023, we mark a quarter century since selective phosphodiesterase type 5 inhibitors (PDE5I) came to market as the first United States Food and Drug Administration (USFDA) approved oral pharmacotherapy for ED.

The past 25 years have seen a major shift in public discourse on sexuality and sexual dysfunction, to a large extent prompted by the safety and ease of availability of these drugs. The positive impact of the drug on men and their partners is undeniable. The advent of PDE5I has not been without controversy, and in some regards, the sheer simplicity of the drugs’ use may have compromised consideration of more deep-seated psychological and interpersonal dimensions of sexuality.

The clear link between ED and cardiovascular disease and even mortality also underscores how simply taking a pill to address the immediate goal of a rigid penis may lead to the person with ED overlooking potentially serious medical problems, of which ED may be a harbinger. In this manuscript, we outline our perspectives on use (and misuse) of PDE5I as a certified sex therapist and a board-certified urologist with interest in sexual medicine. We highlight areas of agreement and disagreement and hopefully provide readers of all disciplines with perspectives on how to optimize sexual wellness for all of our patients, with or without PDE5I.