Erectile Dysfunction
- causes and risk factors
- signs, symptoms, and diagnosis
- pathophysiology
- treatments
- consequences and course
- the patient
- health care team
- community involvement
- resources and references
Erectile Dysfunction, or ED s the consistent or recurrent inability to attain/maintain penile erection, sufficient for sexual performance, lasting at least three months.
Approximately 20% of men over 40 are affected, while over half of men over 70% have ED.
Causes and Risk Factors
Causes of ED include:
- vascular: arterial insufficiency, atherosclerosis
- hypertension
- hyperlipidemia
- smoking
- diabetes
- endocrine: low testosterone
- anatomic: structural abnormality
- neurologic: post-operative, DM
- medications: clonidine, antihypertensives, psychotropics
- excess alcohol
- psychogenic (anxiety, depression)
Signs, Symptoms, and Diagnosis
- history
- physical exam
- lab investigations
- diagnostic imaging
History
Ask questions regarding sexual, medical, and psychosocial history.
Time course: last satisfactory erection, onset, attempts at sexual activity
Quantity
- presence of morning/nighttime erections
- stiffness (1-10)
- ability ot initiate or maintain an erection
Quality
- partner or situation-specific?
- loss of erection before penetration or climax
- degree of concentration required
- percentage of satisfactory sexual attempts
- impact on quality of life and relationship
Physical Exam
Lab Investigations
Evaluate hypothalamic-pituitary-gonadal axis: testosterone (free + total), prolactin, LH
Evaluate risk factors: fasting glucose, HbA1c, lipids
TSH, CBC, urinalysis
Diagnostic Imaging
Vascular diagnostics, such as Dopler or angiography, can be carried out.
Pathophysiology
Treatments
Lifestyle changes
Reducing alcohol and smoking, while increasing exercise, can be of benefit.
Relationship/sexual counseling can help psychogenic ED.
Medications
Phosphoesterase type 5 inhibitors:
sildenafil (Viagra) - take 0.5-4hr before intercourse; can last up to 24h
tadalafil (Cialis) - can last up to 36 hours
vardenafil (Levitra) - take 1 hour prior
alpha adrenergic blockers, ie yohimbe
serotonin antagonist and reultake inhibitor, ie trazodone
Consequences and Course
The Patient
Health Care Team
Community Involvement
Resources and References