Last reviewed: 20 Sep 2020
Last updated: 01 Feb 2019



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
More 1st investigations to order

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
More investigations to consider

Treatment algorithm


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.

Peer reviewersVIEW 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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