The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

The Princeton III Consensus Recommendations, published in 2012, provided updated guidelines for managing erectile dysfunction (ED) in the context of cardiovascular disease (CVD). The conference, which took place from November 8 to 10, 2010, aimed to optimize sexual function and cardiovascular health. The recommendations emphasized the importance of evaluating cardiovascular risk in men with ED who do not have known CVD, and the need for cardiologic work-up in certain cases. It also called for reevaluation of cardiac risk associated with sexual activity in men with known CVD. The panel suggested using exercise ability and stress testing to ensure a man's cardiovascular health is adequate for the physical demands of sexual activity before prescribing ED treatment. The consensus highlighted the link between ED and CVD, suggesting that ED may be an indicator of asymptomatic CVD that could benefit from risk reduction. It was recommended that men with ED be assessed for occult cardiac disease and that risk factor modification and treatment of vascular disease should precede ED treatment in high-risk cardiac patients. The document also mentioned the controversial recommendation to assess testosterone levels in men with ED, especially those who have not responded to PDE5 inhibitors, noting that this may conflict with other medical society recommendations.