Erectile dysfunction
Summary
Definition
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
- Sexual Health Inventory for Men
- fasting blood glucose
- lipid profile
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
Treatment algorithm
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 DifferentialsGuidelines
- Erectile dysfunction
- Peyronie’s disease and congenital penile curvature
More GuidelinesPatient leaflets
Erection problems
Erection problems: questions to ask your doctor
More Patient leaflets
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