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Erectile dysfunction

Last reviewed: 9 Nov 2024
Last updated: 18 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abnormalities on exam of penis
  • abnormal androgenization
Full details

Other diagnostic factors

  • premature ejaculation
  • abnormal prostate exam
  • psychosocial stressors
  • Peyronie disease
  • genital pain or numbness
Full details

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
Full details

Diagnostic tests

1st tests to order

  • International Index of Erectile Dysfunction
  • Sexual Health Inventory for Men
  • fasting blood glucose
  • lipid profile
Full details

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
Full details

Treatment algorithm

ACUTE

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.

  • Differentials

    • Premature ejaculation
    • Priapism
    More Differentials
  • Guidelines

    • Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility
    • Sexual and reproductive health: management of erectile dysfunction
    More Guidelines
  • Patient information

    Erection problems

    Erection problems: questions to ask your doctor

    More Patient information
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