Summary
Definition
History and exam
Key diagnostic factors
- abnormalities on exam of penis
- abnormal androgenization
Other diagnostic factors
- premature ejaculation
- abnormal prostate exam
- psychosocial stressors
- Peyronie disease
- genital pain or numbness
Risk factors
- coronary arterial disease
- peripheral arterial disease
- hyper/hypothyroidism
- psychosexual/relationship problems
- excess alcohol intake
- hypertension
- hyperlipidemia
- diabetes mellitus
- obesity
- smoking
- metabolic syndrome
- neurologic disease
- radical pelvic surgery
- spinal cord injury
- pelvic fracture
- Peyronie disease
- depression
- premature ejaculation
- hypogonadism
- long-distance cycling
- antihypertensive use
- antidepressant use
- corticosteroid use
- antiandrogenic agent use
- desire/libido disorders
- benign prostatic hyperplasia
Diagnostic tests
1st tests to order
- International Index of Erectile Dysfunction
- Sexual Health Inventory for Men
- fasting blood glucose
- lipid profile
Tests to consider
- hemoglobin A1c in diabetic men
- testosterone (morning)
- follicle-stimulating hormone and luteinizing hormone
- thyroid-stimulating hormone
- prolactin
- Doppler ultrasonography
- pelvic/penile angiography
Treatment algorithm
all patients (except those with Peyronie disease, psychogenic ED, and previous pelvic injury with arterial compromise)
Peyronie disease
previous pelvic injury with arterial compromise
psychogenic ED
Contributors
Authors
Omer Raheem, MD, MSc, MCh, MRCS
Assistant Professor of Surgery and Urology
The University of Chicago Medical Center
Pritzker School of Medicine
Chicago
IL
Disclosures
OR declares that he has no competing interests.
Anjali Shekar, MD
Urology Resident
The University of Chicago Medical Center
Pritzker School of Medicine
Chicago
IL
Disclosures
AS declares that she has no competing interests.
Acknowledgements
Dr Omer Raheem and Dr Anjali Shekar would like to gratefully acknowledge Dr Edward D. Kim, Dr Andrew C. Kramer, Dr Daniel H. Williams, and Dr James K. Kuan, previous contributors to this topic.
Disclosures
EDK, 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.
References
Key articles
Dewitte M, Bettocchi C, Carvalho J, et al. A psychosocial approach to erectile dysfunction: position statements from the European Society of Sexual Medicine (ESSM). Sex Med. 2021 Dec;9(6):100434.Full text Abstract
Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. J Urol. 2018 Sep;200(3):633-41.Full text Abstract
Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012 Aug;87(8):766-78.Full text Abstract
Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Premature ejaculation
- Priapism
More DifferentialsGuidelines
- Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility
- Sexual and reproductive health: management of erectile dysfunction
More GuidelinesPatient information
Erection problems
Erection problems: questions to ask your doctor
More Patient information
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