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Erectile dysfunction

Erectile dysfunction
Other namesImpotence
SpecialtyUrology, sexual medicine, andrology
SymptomsInability to gain or maintain an erection
CausesLow testosterone levels,[1][2] certain prescription drugs,[3][4] neurogenic disorders[3][4][5][2]
Risk factorsCardiovascular disease, diabetes, smoking, stress,[6] mental disorders,[6] ageing,[1] high saturated fat diet,[7][8] kidney disease[9]
Diagnostic methodDepends if psychological or physiological; absence of involuntary erections suggests physiological[4]
Differential diagnosisHypogonadism,[4] prolactinoma[4]
PreventionAdequate exercise[10]
TreatmentPenis pump,[11] counseling (psychological treatment)[12]
MedicationSildenafil, Tadalafil, Vardenafil[13]

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.

The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions like depression, stress, and problems within relationships.[14]

The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.

Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues.[4] In many instances, medication-based therapies are used, specifically PDE5 inhibitors like sildenafil.[13] These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.[4][15]

ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.[14]

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  13. ^ a b Vardi M, Nini A (January 2007). "Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus". The Cochrane Database of Systematic Reviews. 2009 (1): CD002187. doi:10.1002/14651858.CD002187.pub3. PMC 6718223. PMID 17253475.
  14. ^ a b Rosen RC, Khera M (2023). "Epidemiology and etiologies of male sexual dysfunction". In O'Leary MP, Cummingham GR (eds.). UpToDate. Post, TW. Waltham, MA: UpToDate.
  15. ^ Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. (July 2005). Smith J Jr (ed.). "Chapter 1: The management of erectile dysfunction: an AUA update". The Journal of Urology. 174 (1). Elsevier: 230–39. doi:10.1097/01.ju.0000164463.19239.19. ISSN 1527-3792. PMID 15947645. S2CID 1761196.

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