[논문]La dysfonction érectile, vingt ans après

Colson, M.H.; Cuzin, B.; Faix, A.; Grellet, L.; Huyghes, É; .

doi:10.1016/j.sexol.2018.01.015

[해외논문] La dysfonction érectile, vingt ans après
Erectile dysfunction, twenty years after

Sexologies : European journal of sexology and sexual health = Revue européenne de sexologie et de santé sexuelle, v.27 no.1, 2018년, pp.2 - 8

Colson, M.H. (Service d’immuno-hé) , Cuzin, B. (matologie clinique (CISIH), hô) , Faix, A. (pital Sainte-Marguerite, 13009 Marseille, France) , Grellet, L. (Groupement hospitalier É) , Huyghes, É. (douard-Herriot, 69437 Lyon cedex, France)

Abstract ▼ AI-Helper

Summary We are presenting in this article the third updated version of “Guidelines for non-sexologist general practitioners for first-line treatment” for a patient suffering from erectile dysfunction (ED). This work follows the methodology recommended by the French National Health Authority, and includes an in-depth documentary search of medical and scientific bibliographic data. It was conducted by a working group that identified, selected, analysed and summarised the scientific literature used to prepare these guidelines. All the work was reviewed by a reading group that expressed an opinion on the substance and format of these guidelines, in particular concerning their legibility and ease of application. Amongst the main points that have been updated and which are presented in detail in the articles of this issue, we draw attention in particular to: a change in definitions, abandoning the classification of erectile dysfunction by aetiology, dividing it into three types (organic, psychogenic and mixed), preferring a better suited integrated definition, recognising that these various factors can overlap; the issue of the partner's role in triggering or maintaining the patient's ED is today seen as an important factor that should not be overlooked; the high prevalence of ED has been confirmed by recent studies, as well as its steady rise with age. But the older patients would today appear to be more acutely affected in terms of their quality of life. For younger patients, the prevalence of ED can also be high, linked to lack of activity, comorbidities, or excessive consumption of alcohol and/or toxic substances. Vulnerable populations (patients with comorbidities, diabetes, hypertension and cardiovascular pathologies, depression etc.) are today identified as presenting high levels of risk for high prevalence of ED. ED is often an “indicator” of a comorbidity, in particular for certain conditions such as cardiovascular disease, diabetes, depression, or impaired urination. In such cases, its emotional impact is intensified; treatments have also evolved, with the arrival of new drugs, and better structured care to take account of the various organic, psychological and relationship factors. These guidelines were designed as a support for diagnosis and treatment, for first-line management of patients consulting for erectile dysfunction, and are summarised by an algorithm. We have added a Communication Guide to help practitioners to tackle the issue of sexuality with patients whenever this is helpful or necessary.

Abstract

Résumé Nous présentons ici la troisième version actualisée des « Recommandations pour la prise en charge de première intention par le praticien non sexologue » d’un homme souffrant de dysfonction érectile (DE). Ce travail, qui suit la méthodologie recommandée par la Haute Autorité de santé, a comporté une recherche documentaire approfondie des banques de données bibliographiques médicales et scientifiques. Il a été effectué par un groupe de travail constitué, qui a identifié, sélectionné, analysé et synthétisé la littérature scientifique utilisée pour rédiger l’argumentaire et les recommandations. L’ensemble de ce travail a été revu par un groupe de lecture, qui a donné un avis sur le fond et la forme des recommandations, en particulier sur leur lisibilité et leur applicabilité. Parmi les principaux points d’actualisation qui seront développés dans les articles de ce numéro, nous noterons principalement : l’évolution des définitions, avec l’abandon de la classification de la dysfonction érectile étiologique, en trois types (organique, psychogène et mixte), au profit d’une définition intégrée plus adaptée, reconnaissant l’intrication de ces différents facteurs ; la question du rôle du partenaire dans le déclenchement ou le maintien de la dysfonction érectile représente aussi aujourd’hui un point important qui n’est plus à négliger ; la forte prévalence de la DE est bien confirmée par les études récentes ainsi son augmentation régulière avec l’âge. Mais les plus âgés en semblent aujourd’hui davantage affectés dans leur qualité de vie. Chez les plus jeunes, la prévalence de la DE peut aussi s’avérer importante, en lien avec la sédentarité, les comorbidités, ou la consommation d’alcool et/ou de substances toxiques. Des populations vulnérables (patients souffrant de comorbidités, diabète, hypertension et pathologies cardiovasculaires, dépression…) sont aujourd’hui identifiées comme à risque important pour la forte prévalence de la DE chez eux. Elle peut être fréquemment s’y révéler comme « l’indicateur » d’une comorbidité, en particulier dans certaines affections (cardiovasculaires, diabète, dépression, troubles mictionnels du bas appareil urinaire). Elle y revêt aussi un impact émotionnel majoré ; les traitements ont eux aussi évolué, avec l’apparition de nouveaux traitements pharmacologiques, et des prises en charge mieux structurées prenant en compte les différents facteurs organiques, psychologiques et relationnels. Ces recommandations ont été conçues comme une aide à la fois diagnostique et thérapeutique pour la prise en charge en première intention d’un patient venant consulter pour dysfonction érectile, avec un algorithme la résumant. Nous y avons adjoint un guide de communication permettant à tout praticien d’aborder la question de la sexualité avec son patient lorsque cela s’avère utile ou nécessaire.

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