Which of the following describes first-line pharmacologic therapy for organic impotence?

• A. Beta-blockers and diuretics
• B. PDE5 inhibitors (Sildenafil, Tadalafil, Vardenafil) with adjunct therapies; testosterone if low
• C. Antidepressants only
• D. Hormone therapy only

Answer: (B)

First-line pharmacologic therapy for organic erectile dysfunction centers on oral PDE5 inhibitors—sildenafil, tadalafil, and vardenafil. These drugs block the enzyme PDE5, increasing cGMP levels in the smooth muscle of the corpora cavernosa. When sexual arousal triggers nitric oxide release, higher cGMP leads to smooth muscle relaxation and greater penile blood flow, making it easier to achieve and maintain an erection. They enhance the natural erectile response rather than causing an automatic erection.

Testosterone replacement is considered only if low testosterone is confirmed, since hypogonadism can contribute to diminished libido and erectile quality but isn’t routinely used in all cases.

PDE5 inhibitors must not be used with nitrates due to risk of severe hypotension, a crucial safety point.

Other options listed aren’t first-line for organic ED: beta-blockers and diuretics can worsen erectile function, antidepressants often cause sexual side effects, and hormone therapy alone is inappropriate without evidence of hypogonadism.