School of Sexology, Course of Medical Sexology, Department of Clinical, Applied and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy.
J Sex Med. 2013 Oct;10(10):2359-69. doi: 10.1111/jsm.12315.
In male sexual dysfunction (MSD), the presence of sexual comorbidities is relatively frequent. However, what is still a matter of controversy is what the first-line therapy in these patients should be.
Three scientists and the editor of the Controversies section, all experts in the medical treatment of MSD, present different perspectives on the use of phosphodiesterase type 5 inhibitors (PDE5), testosterone and dapoxetine in erectile dysfunction (ED), hypogonadism, and premature ejaculation (PE). The psychological aspects are discussed by an outstanding expert in psychosexology.
Expert opinion supported by the critical review of the currently available literature.
Testosterone should be used before PDE5s in hypogonadal men with comorbid ED; PDE5s should be used before dapoxetine in PE patients with comorbid ED, and counseling should be offered to all subjects with MSD.
Although the answer to the question "which should be first?" is controversial in almost all MSDs, intuition, experience, and evidence should guide the choice of which treatment should be used first. This decision is highly critical in influencing the therapeutic outcome as well the patient's and couple's adherence to treatment.
在男性性功能障碍（MSD）中，存在性合并症的情况相对较为常见。然而，这些患者的一线治疗方法仍存在争议。
三位科学家和争议部分的编辑，均为 MSD 医学治疗方面的专家，对磷酸二酯酶 5 抑制剂（PDE5）、睾酮和达泊西汀在勃起功能障碍（ED）、性腺功能减退症和早泄（PE）中的应用提出了不同的观点。一位杰出的性心理学家就心理方面进行了讨论。
现有文献批判性回顾支持的专家意见。
在伴有 ED 的性腺功能减退症男性中，应在 PDE5 之前使用睾酮；在伴有 ED 的 PE 患者中，应在达泊西汀之前使用 PDE5，并且应向所有 MSD 患者提供咨询。
尽管在几乎所有 MSD 中，“应该先使用哪种药物？”这个问题的答案存在争议，但直觉、经验和证据应该指导选择应先使用哪种治疗方法。这一决策对于影响治疗结果以及患者和伴侣对治疗的依从性至关重要。
