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Erectile dysfunction: information for the health administration


The World Health Organization (WHO) has defined sexual health as a basic human right that includes the ability to enjoy and control sexual behavior, freedom to express sexuality, and freedom from fear, shame, guilt, false beliefs or other factors that harm sexual relationships, as well as freedom from organic diseases or other deficiencies that interfere with sexual and reproductive function.1

When disturbances occur in the sex life of an individual, he or she may suffer psychological consequences that negatively impact quality of life, self-esteem, partner and family relationships, and work and social environment.2 Men who highly value their sex lives may even develop depressive disorders of varying severity.3

Etiology of erectile dysfunction

Erectile dysfunction (ED) is highly prevalent medical disorder. The WHO recognizes ED as a health problem that can be as disabling and severe as a fracture of the radius, infertility, rheumatoid arthritis, or angina pectoris.4 ED is defined as the persistent inability to attain and sustain an erection adequate for satisfactory sexual intercourse.5

Epidemiological studies have repeatedly shown the high prevalence of ED. The Epidemiological Study on Male Erectile Dysfunction (EDEM), conducted in Spain with strict methodology, revealed that 12% of men suffer some degree of ED.6 This means that approximately 2 million Spanish men are affected by this health problem.

ED is often associated with psychological problems, highly prevalent diseases (eg, diabetes mellitus, hypertension, heart disease, neurological disease, prostate surgery) and a variety of drugs frequently used to treat common diseases.7 It is not uncommon for ED to be the first symptom of an important general health problem5 that can be detected during the process of diagnosing ED.

Responsibilities of healthcare providers

It is logical that sexual dysfunction specialists and other physicians who treat patients with risk factors for ED be responsible for assessing the various scientific and social factors involved in this problem, and for dispensing appropriate advice and information to the general population. These thought leaders are also relied on to communicate to competent health administrations their views and suggestions as possible solutions for improving the sexual health of the citizens of Spain.

As physicians involved in the care of patients with ED, we are aware that although it is not a life-threatening disease, it can have a major negative effect on patient and partner quality of life.2 We are also aware that healthcare resources are limited, but this should not make us renounce our obligation to demand better care of the sexual health of the population, which would undoubtedly lead to an improvement in their quality of life.

We believe that there are many problems related to the care offered by the healthcare system to citizens with regard to their sex life and that it is justified to ask whether the competent authorities have considered the possibility of developing a program to provide solutions to this problem. The current reality is that there are discrepancies among different areas of the country, and in a few small areas, there are well-organized infrastructures to care for sexual disorders. Broadly speaking, the patient should be able to consult his primary care physician about his sexual dysfunction, who should make an initial assessment and even manage possible first-line therapy in cases of low complexity. In other cases, the physician should be able to refer the patient to specialists in the organic or psychogenic aspects of the disorder who have the infrastructure required for appropriate testing and treatment. This ideal situation requires the following:

  1. 1

    To provide adequate sexual health training to physicians as part of their basic medical training and to professionals specializing in this area of health.

  2. 2

    To ensure the presence of an adequate number of specialists with the necessary resources to care for patients with sexual dysfunctions in all areas of the country. For example, there should be a focus on having staff specifically trained in andrology and the availability of professionals with basic training in sex therapy within the public health system, either in psychiatric units, andrology departments, or secondary care centers.

  3. 3

    Finally, the possibility of offering the most appropriate treatment to each patient should be considered. An incongruent situation currently exists in which the public health system finances invasive and complex treatments such as penile drug injections and prostheses but does not finance first-line treatments such as oral drugs, which are noninvasive and highly effective.

Advances in our understanding of sexual disorders, as well as the availability of easy-to-use drugs with good safety, efficacy, and tolerability profiles, has favored an increase in the demand for care. This demand for care cannot always be satisfied because of the lack of resources, not only material but also human because the training received in this field has been less than ideal.


Given the need to respond to and coordinate some of the aspects referred to earlier, the Spanish Association of Andrology (ASESA) in conjunction with the Spanish Association of Urology (AEU) proposed the organization of a forum, which invited all medical societies involved in the treatment of men affected by ED, to assess the different problems related to ED. The main objectives of the forum were

  • To transmit a series of recommendations to the general public on how to have an adequate sex life, prevent dysfunctions, and to see a physician when a problem occurs.

  • To prepare reliable guidelines for ED, adapted to the reality of Spain, with the scientific bodies involved

    • To help any physician involved in the care of a patient with ED to perform an adequate assessment and to treat or refer the patient to another specialist when indicated.

    • To help specialists (eg, endocrinologists, cardiologists, nephrologists, internists, rehabilitators, psychiatrists) who treat patients with diseases associated with ED.

  • Issue a report on the current situation to the public health administration.


In order to achieve better healthcare in Spain for patients with ED, it will be necessary to provide more sexual health training for primary care physicians and specialists and to encourage close collaboration between them. Moreover, broader access to healthcare facilities and ED treatment is needed in all parts of the country, not just the metropolitan areas. It is our hope that the recommendations provided here will ultimately result in improved care for patients with ED.


  1. 1

    Department of Reproductive Health and Research. Gender and reproductive rights: Sexual health. World Health Organization, Available at: Accessed November 25, 2003.

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    NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83–90.

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Correspondence to J M Pomerol.

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Pomerol, J. Erectile dysfunction: information for the health administration. Int J Impot Res 16, S40–S41 (2004).

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  • erectile dysfunction
  • sexual health
  • public health system
  • sexual health training

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