Peter Pommerville, BA, MD, FRCS(C), Director of Research, Can-Med Clinical Research, Inc.; Clinical Instructor, University of British Columbia; Clinical Instructor, University of Victoria; Consulting Urologist, Vancouver Island Health Authority, Vancouver, BC.

It is estimated that 50% of men between 40 and 70 have erectile dysfunction (ED). The number of men with ED rises to 65% or greater over age 70. Despite the fact that men in this age range have significant medical comorbidities causing their ED, they have often cared for a spouse with a terminal illness. In search of companionship, they become acquainted with a woman who has just been through a similar circumstance. Therefore, it’s usual for men to have performance anxiety contributing to their ED. Proper diagnosis and assessment to determine the etiology of ED is usually done by the primary care physician, with possible follow-up by an urologist or psychiatrist if the main cause is deemed to be organic or psychological, respectively. In some cases, there is overlap as medications such as antidepressants may interfere with sexual function.
Primary care physicians, geriatricians, and allied health care professionals charged with the management of these older men should be empathetic towards their sexual health. Safe and effective treatments for ED are available to permit these couples to enjoy a healthy sexual experience in their elder years.
Key words: erectile dysfunction, diabetes, vardenafil, sildenafil, tadalafil.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Peter Pommerville, BA, MD, FRCS(C), Director of Research, Can-med Clinical Research, Inc.; Consulting Urologist, Vancouver Island Health Authority,
Vancouver, BC.

Abstract:Sildenafil was introduced in Canada in 1998 as the first effective oral therapy for erectile dysfunction (ED). Since its release, sidenafil has been proven to be an effective and safe treatment for ED in older patients with multiple medical problems. In the last year, two new PDE5 inhibitors have been approved for ED treatment: vardenafil and tadalafil. There are subtle differences between the three phosphodiesterase type 5 (PDE5) inhibitors with respect to efficacy, dosing instructions, and adverse event profiles. All three PDE5 inhibitors have exhibited efficacy and safety in the cardiac patient as long as he is not reliant upon the regular use of nitroglycerine. This article reviews the similarities and differences between the three PDE5 inhibitors, and refers to patient attitudes in Canada towards sexual activity and its treatment with these agents, as discussed in the Canadian Sexual Satisfaction Survey (CSSS).

Key words: Erectile dysfunction, phosphodiesterase inhibitor, sildenafil, vardenafil, tadalafil

Introduction
Physicians in Canada are treating an increasingly aging population, and coupled with this is an increase in the incidence of specific diseases that may arise as a result of the breakdown of biological mechanisms (e.