Last reviewed: 9 Apr 2021
Last updated: 01 Feb 2019



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 investigations

1st investigations to order

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

Investigations 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


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.

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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