My doctor: MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

Sexual Dysfunction describes any of a group of sexual disorders characterized by inhibition either of sexual
desire or the physiological changes that usually characterize sexual response. Sexual dysfunction disorders
are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disor-
ders, and sexual pain disorders.
Male sexual dysfunction may reflect problems with the following factors: Libido, ejaculation, erectile func-
tion or a combination of these factors. Erectile Dysfunction (ED), also known as impotence, is the inability
to achieve and maintain penile erection and thus engage in sexual intercourse. This is a common, treatable
condition affecting an estimated 18 million men in the United States alone. Yet, data suggest that less than
10% of affected men actually receive treatment. Male sexual dysfunction may be a result of one or more of
the following conditions: medication side effects, endocrine disorders, peripheral vascular disease, neuro-
logical dysfunction, penile diseases, psychological disorders, and lifestyle factors. Once male sexual dys-
function is diagnosed, each of these potential causes must be carefully addressed prior to initiating
treatment.

Services eligible for coverage for men with sexual dysfunction due to organic

causes include:

a. Treatment of the underlying organic/medical condition causing sexual dysfunction.
b. Oral prescription medications for erectile dysfunction such as Viagra®, Levitra® and Cialis®.
Most BCBSNC benefit plans have a limit of 4 tablets per 30 days. These medications have been
shown to potentiate hypotensive effects of nitrates and are contraindicated in patients taking any
form of nitrates or have known allergy to nitrates. Caution should also be taken in patients taking
alpha-blockers as the combination may produce hypotension. Safety and efficacy of use with other
treatments for erectile dysfunction have not been studied and are not recommended. Viagra®,
Levitra® and Cialis® are not indicated for use by newborns, children or women.
c. Penile injection therapy which involves the self-injection of medications into the base of the penis.
Papavarine, phenotolamine, and/or prostaglandin E
1
(alprostadil) (Caverject®, Edex®) are com-
monly used. This type of therapy is most useful when used for organic impotence due to neuro-
genic causes and lesser for vascular problems. Most BCBSNC benefit plans have a limit of 4 units
per 30 days.
d. MUSE (Medicated Urethral System for Erection). This consists of a urethral suppository (alpros-
tadil) in a very small, smooth plastic applicator. Once the applicator is in place, a button is pushed
down which pushes the suppository out into the urethra where it is absorbed. Most BCBSNC ben-
efit plans have a limit of 4 units per 30 days.
e. A vacuum erection system which is an external device used to provide erection in men and may be
used in some cases as an alternative to the implanted device.
f.
Surgical implantation of a Penile Prosthesis. Implantation of a penile prosthesis may be considered
medically necessary for men who meet all of the following criteria:
i.
Results from Nocturnal Penile Tumescence (NPT) and/or rigidity testing (e.g., Rigi-scan) indi-
cate that the erectile dysfunction is organic and not psychogenic in nature; and
ii. Patient has attempted the above less invasive therapies (a, b, c, d, and/or e) with failure to have
an adequate erection.
g. Surgical revascularization. Penile revascularization may be considered medically necessary only in
men less than 50 years old who meet all of the following criteria:
i.
The erectile dysfunction is the direct result of an arterial injury caused by blunt trauma to the
pelvis and/or perineum; and
ii. A focal blockage of arterial inflow is demonstrated by duplex Doppler ultrasonography or arte-
riography; and
iii. Diagnostic work-up reveals normal corporeal venous function; and
iv. Member is not diabetic and has no evidence of systemic vascular occlusive disease; and
v. Member is not actively smoking.

When Treatment of Male Sexual Dysfunction is not covered

•
When the above medical criteria and guidelines are not met.
•
Viagra®, Levitra® and Cialis® are not indicated for newborns, children, or women.

Policy: Sexual Dysfunction Treatment, Male

•
Treatment of sexual dysfunction not related to organic disease is excluded under most plans.
•
Sural nerve graft in association with radical prostatectomy is considered investigational.
•
Oral yohimbine therapy.
•
Arterial reconstructive procedures, dorsal vein arterialization procedures, or penile venous occlusive
surgery (e.g., venous ligation, dorsal vein ligation) in men with erectile dysfunction secondary to arte-
riosclerotic occlusive disease are considered investigational.
•
Topical cream or gel containing vasodilators are considered investigational.
•
Extracorporeal shock wave therapy (ESWT) for Peyronie’s Disease is considered investigational.

Policy: Sexual Dysfunction Treatment, Male

Iatrogenic
any adverse condition in a patient occurring as a result of treatment by a physician or surgeon, espe-
cially to infections acquired by the patient during the course of treatment.
Neurogenic
arising from or caused by the nervous system.
Neurological
pertains to the nervous system.
Organic
refers to a physiological cause; pertaining to or arising from an organ or the organs.
Potentiate
increasing of potency; particularly, the synergistic action of two drugs, being greater than the sum of the
effects of each used alone.
Prostatectomy
surgical removal of the prostate gland.
Vascular
pertains to blood vessels in the body.

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Sunday, October 12, 2008

MALE SEXUAL DYSFUNCTION. Popular drug: Cialis and viagra

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