Erectile dysfunction

Last reviewed: 4 Jun 2022
Last updated: 01 Feb 2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abnormalities on examination of penis
  • abnormal androgenisation
More key diagnostic factors

Other diagnostic factors

  • premature ejaculation
  • abnormal prostate examination
  • psychosocial stressors
  • Peyronie's disease
  • genital pain or numbness
Other diagnostic factors

Risk factors

  • coronary arterial disease
  • peripheral arterial disease
  • hyper/hypothyroidism
  • psychosexual/relationship problems
  • excess alcohol intake
  • hypertension
  • hyperlipidaemia
  • diabetes mellitus
  • obesity
  • smoking
  • metabolic syndrome
  • neurological disease
  • radical pelvic surgery
  • spinal cord injury
  • pelvic fracture
  • Peyronie's disease
  • depression
  • premature ejaculation
  • hypogonadism
  • long-distance cycling
  • antihypertensive use
  • antidepressant use
  • corticosteroid use
  • anti-androgenic agent use
  • desire/libido disorders
  • benign prostatic hyperplasia
More risk factors

Diagnostic investigations

1st investigations to order

  • International Index of Erectile Dysfunction
  • Sexual Health Inventory for Men
  • fasting blood glucose
  • lipid profile
More 1st investigations to order

Investigations to consider

  • haemoglobin A1c in diabetic men
  • testosterone (morning)
  • follicle-stimulating hormone and luteinising hormone
  • thyroid-stimulating hormone
  • prolactin
  • Doppler ultrasonography
  • pelvic/penile angiography
More investigations to consider

Treatment algorithm

ACUTE

all patients (except those with Peyronie's disease, psychogenic ED, and previous pelvic injury with arterial compromise)

Peyronie's disease

previous pelvic injury with arterial compromise

psychogenic ED

Contributors

Authors

Edward D. Kim, MD

Professor of Surgery

Division of Urology

University of Tennessee Graduate School of Medicine

Knoxville

TN

Disclosures

EDK declares that he has no competing interests.

Acknowledgements

Dr Edward D. Kim would like to gratefully acknowledge Dr Andrew C. Kramer, Dr Daniel H. Williams, and Dr James K. Kuan, previous contributors to this topic.

Disclosures

ACK, DHW, and JKK declare that they have no competing interests.

Peer reviewers

Justin Vale, MS, FRCS

Urological Surgeon

Imperial Healthcare NHS Trust

London

UK

Disclosures

JV declares that he has no competing interests.

Arthur L. Burnett, MD

Professor of Urology

Cellular and Molecular Medicine

The James Buchanan Brady Urological Institute

The Johns Hopkins Hospital

Baltimore

MD

Disclosures

ALB declares that he has no competing interests.

  • Differentials

    • Premature ejaculation
    • Priapism
    More Differentials
  • Guidelines

    • Erectile dysfunction
    • Peyronie’s disease and congenital penile curvature
    More Guidelines
  • Patient leaflets

    Erection problems

    Erection problems: questions to ask your doctor

    More Patient leaflets
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