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Erectile Dysfunction: Symptoms, Diagnosis & Treatment

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Erectile Dysfunction (ED): Symptoms, Diagnosis & Treatment

Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse. Although this definition applies to a substantial number of men, ED is not considered normal at any age. It may result from psychological, neurologic, hormonal, arterial, or venous insufficiency or from a combination of these factors. ED is not only a disorder of the penile arteries and veins but also a disorder of the heart, brain, and emotions. The most important organic causes of ED are arterial insufficiency and nerve injury. These factors are often interrelated, and many men with arterial insufficiency will also have nerve injury.

Causes

The most common organic causes of erectile dysfunction are related to vasculogenic, neurogenic, endocrinologic, and anatomic factors. Many men with erectile dysfunction have more than one risk factor. The likelihood of erectile dysfunction increases with age, with about 5% of 40-year-old men and 15% to 25% of 65-year-old men having the disorder.

Risk factors

Several risk factors have been associated with erectile dysfunction, including the following:

  • Advanced age
  • Diabetes mellitus
  • Cardiovascular disease (eg, coronary artery disease, hypertension, hyperlipidemia)
  • Neurologic disorders (eg, Alzheimer disease, multiple sclerosis, Parkinson disease)
  • Pelvic surgery (eg, radical prostatectomy, pelvic irradiation)
  • Pelvic trauma
  • Peyronie disease
  • Psychologic disorders (eg, depression)
  • Smoking
  • Substance abuse (eg, alcohol, cocaine, nicotine)

Signs and symptoms

Patients with erectile dysfunction may present with the following:

  • Loss of nocturnal erections
  • Reduced morning erections
  • Reduced or absent erections with sexual stimulation
  • Soft erections
  • Shortened erections
  • Decreased frequency or quality of morning erections
  • Decreased libido
  • Anorgasmia
  • Delayed ejaculation

Patients should also be asked specifically about symptoms suggestive of low testosterone levels (eg, loss of body hair, decreased libido, erectile dysfunction, hot flushes) because these may be treatable with exogenous testosterone replacement therapy.

Evaluation

The evaluation of erectile dysfunction should include a medical and psychosocial history, a physical examination, laboratory testing, and a review of symptoms. The medical and psychosocial history may reveal risk factors for erectile dysfunction and help distinguish organic from psychogenic causes. Important risk factors include the following:

  • A history of cardiovascular disease
  • A history of diabetes mellitus
  • A family history of cardiovascular disease
  • A family history of diabetes mellitus
  • A history of pelvic surgery
  • A history of pelvic trauma
  • A personal or family history of psychiatric illness
  • A personal or
Erectile dysfunction occurs when a man cannot get an erection or cannot maintain an erection long enough to have sexual intercourse. For only 20% of men with erectile dysfunction, the cause is due to a psychological problem or disorder. When the cause of erectile dysfunction is due to a physical condition, erectile dysfunction is not a reflection of you or of your sexual partner, since lack of arousal is not the problem.

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