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
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.
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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