Men with Mild Erectile Dysfunction Benefit from Sildenafil Treatment

Introduction. Sildenafil treatment has not been evaluated in a double-blind, placebo-controlled (DBPC) trial specific to men with mild erectile dysfunction (ED), defined by a 22-25 score on the International Index of Erectile Function-erectile function domain (IIEF-EF). Aim. To assess sildenafil efficacy in sexually dissatisfied men with mild ED. Main Outcome Measures. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), IIEF, Quality of Erection Questionnaire (QEQ), Erection Hardness Score (EHS 4 = completely hard/fully rigid), general efficacy questions (GEQs), event log questions (hardness sufficient for penetration, duration sufficient for successful intercourse, ejaculation/orgasm, and second erection within 24 hours), and analog scales (erection firmness, reliability, and maintenance, and general sexual performance). Methods. Eight-week DBPC flexible-dose (25, 50, or 100 mg) trial with 6-week, open-label (OL) extension. Results. One hundred and seventy-six men were randomized (mean +/- standard deviation: age, 50 +/- 12 year; ED duration, 3.5 +/- 3.2 year). Most had organic or mixed ED. For sildenafil vs. placebo, 66% vs. 89% titrated to 100 mg and efficacy at DBPC end was better, including the EDITS Index score (least squares mean [standard error], 80.3 [2.3] vs. 62.1 [2.5]; P < 0.0001); treatment satisfaction (EDITS Index score > 50 in 89% vs. 63%; P = 0.0001); no ED (IIEF-EF >= 26 in 58% vs. 39%; P < 0.05); GEQs (>= 4.9-fold greater odds of improved erections and ability to have sexual intercourse); and EHS 4 (47.2% vs. 25.2% of occasions; P < 0.0001). At OL end, 93% of men were satisfied (EDITS Index score > 50), 77% had no ED, and >= 89% were GEQ responders; mean scores on IIEF domains, the QEQ, and analog scales were > 80% of the maximum; 60% of occasions had EHS 4; and event log responses were positive on > 80% of occasions, except for second erections (41.9%). Headache, nasal congestion, and flushing, mostly mild to moderate, were the most common adverse events. Conclusion. Men with mild ED derive substantial benefit from sildenafil treatment. Benard F, Carrier S, Lee JC, Talwar V, and Defoy I. Men with mild erectile dysfunction benefit from sildenafil treatment. J Sex Med 2010;7:3725-3735.