Last reviewed: September 2018
Last updated: March  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • abnormalities on examination of penis
  • abnormal androgenisation

Other diagnostic factors

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

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

Diagnostic investigations

1st investigations to order

  • International Index of Erectile Dysfunction (IIEF)
  • Sexual Health Inventory for Men (SHIM)
  • fasting blood glucose
  • fasting lipid profile
Full details

Investigations to consider

  • haemoglobin A1c in diabetic men
  • testosterone (morning)
  • FSH and LH
  • PSA
  • TSH
  • prolactin
  • Doppler ultrasonography
  • pelvic/penile angiography
Full details

Treatment algorithm


Authors VIEW ALL

Professor of Surgery

Division of Urology

University of Tennessee Graduate School of Medicine




EDK declares that he has no competing interests.

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

Peer reviewers VIEW ALL

Urological Surgeon

Imperial Healthcare NHS Trust




JV declares that he has no competing interests.

Professor of Urology

Cellular and Molecular Medicine

The James Buchanan Brady Urological Institute

The Johns Hopkins Hospital




ALB declares that he has no competing interests.

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