Erectile dysfunction
Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance for at least 6 months, most often from vascular, neurologic, medication, endocrine, or psychological causes, and is a significant marker of coronary risk. Diagnosis is clinical from history and exam with targeted labs, and first-line treatment is an oral phosphodiesterase-5 inhibitor unless the patient takes nitrates.
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What this article covers
- Overview
Erectile dysfunction (ED) is the inability to achieve or maintain an erection necessary for satisfactory sexual performance, persisting for at least 6 months.
- Epidemiology
ED is the most common male sexual disorder and increases in prevalence with age, reflecting the cumulative burden of vascular, neurologic, and endocrine risk factors across the decades.
- Risk factors
Coronary/peripheral atherosclerosis, the leading organic cause, from impaired penile arterial blood flow.
- Pathophysiology
Sexual stimulation activates the autonomic erection center, sending parasympathetic (S2-S4) and sympathetic (T12-L2) input to the cavernous nerves that regulate penile blood flow.
- Clinical features
Difficulty achieving or maintaining an erection sufficient for satisfactory sexual performance, persisting for at least 6 months, is the defining feature.
- Differential diagnosis
Psychogenic ED: situational, worse with intercourse than masturbation, with preserved nocturnal and early-morning erections, unlike organic ED where nocturnal erections are typically lost.
- Diagnosis
ED is a clinical diagnosis established by a detailed history and physical examination documenting difficulty achieving or maintaining an erection sufficient for satisfactory sexual performance for at…
- Management
First, address reversible contributing factors: review the medication list for ED-associated drugs and consider switching or stopping the offending agent, and initiate lifestyle modification (smoking…
- Complications
Missed cardiovascular risk-factor identification, since ED without clear etiology is a marker for undiagnosed coronary arteriosclerosis; failure to evaluate risk factors delays cardiovascular risk reduction.
- Prognosis
Most men with ED respond well to first-line oral PDE5 inhibitor therapy, with similar efficacy across the approved agents.
- Prevention
Screen for and treat to target cardiovascular risk factors (blood pressure <130/80 mm Hg, LDL cholesterol per atherosclerotic risk category, hemoglobin A1c individualized target in diabetes) as part…
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