There is a high prevalence and incidence of erectile dysfunction (ED) worldwide, and screening should take place as part of routine health assessment.
May be associated with established cardiovascular risk factors or be a precursor to significant cardiovascular, psychological, or endocrine disease.
Treatment using oral phosphodiesterase-5 inhibitors is first line therapy.
The five treatment options include pills, injections, suppositories, vacuum devices, and penile implants. Treating hypogonadism with testosterone supplementation may be regarded as a sixth option, though not currently a definitive organic ED treatment.
Complex patients and treatment failures should be evaluated by a urologist if continued therapy is desired.
Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual performance.
History and exam
- coronary arterial disease
- peripheral arterial disease
- psychosexual/relationship problems
- excess alcohol intake
- diabetes mellitus
- metabolic syndrome
- neurological disease
- radical pelvic surgery
- spinal cord injury
- pelvic fracture
- Peyronie's disease
- premature ejaculation
- long-distance cycling
- antihypertensive use
- antidepressant use
- corticosteroid use
- anti-androgenic agent use
- desire/libido disorders
- benign prostatic hyperplasia
Edward D. Kim, MD
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 topic.
ACK, DHW, and JKK declare that they have no competing interests.
Justin Vale, MS, FRCS
Imperial Healthcare NHS Trust
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
ALB declares that he has no competing interests.
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