The patient should be inquired about any history of diabetes mellitus, hypertension, cardiovascular diseases, prostate surgery or recent trauma. History of drugs, alcohol and caffeine intake should also be carefully taken. Psychological history regarding any worries, depression or recent significant event e.g. divorce should also be taken.
The physical examination should include the measurement of blood pressure, peripheral pulses and sensations. Examination of the genitalia should be performed to look for any lesions such as penile plaques, small testis, prostate carcinoma or infection. The size and texture of testes should also be inspected. It is also necessary to look for penile abnormalities such as priapism, Peyronie disease and epispadias.
Additional workup includes evaluation of the following:
The best solution for every patient should be identified and the partner should preferably be included in the discussion.
Two types of devices are used for treating erectile dysfunction.
Surgical options include:
Sexual counselling is an essential part of the treatment. The emotional aspect should be addressed with active involvement of the partner in order to reduce stress and improve the patient’s quality of life.
Erectile dysfunction results from psychogenic causes or due to any organic disease.
The psychogenic causes of erectile dysfunction include depression, performance anxiety and post-traumatic stress disorder
There are many organic abnormalities that may lead to erectile dysfunction.
Erectile dysfunction is more common in the elderly with up to 25% prevalence in men in their 60’s and 89% in those in their 80’s, seriously affecting their quality of life  . It is also more common in the lower socioeconomic classes.
Erection of the penis is controlled by a balance between contraction and relaxation of blood vessels, and the action of the ischiocavernous muscle. Contraction is mediated by noradrenaline and endothilin 1 whereas relaxation is mediated by nitric oxide, acetyl choline and adenosine triphosphate.
Erection of the penis requires a coordinated interaction of the peripheral nerves (S2 to S4), vascular events and events in corpora of the penis. Nitric oxide locally relaxes the vasculature of corposal smooth muscle with a half-life of about 5 seconds. Due to this relaxation, blood fills the corposa. Furthermore, there is occlusion of venules beneath tunica albuginea. This raises the intercarvosal pressure as high as 100mmHg. The ischiocavernous muscle then contracts and causes the pressure to rise up to 200 mmHg.
A normal level of testosterone is essential for the proper physiology of erection. Low levels of testosterone are associated with low libido, poor erection and ejaculatory dysfunction . Erectile dysfunction occurs when this complex cycle of events is disrupted due to vascular, endocrine, psychogenic or other causes .
The following measures can be helpful in prevention of erectile dysfunction.
Erectile dysfunction refers to an inability to achieve or maintain erection for intercourse. An underdiagnosed disorder, it occur either due to sensory abnormalities or decreased blood flow to the penis. The causes of erectile dysfunction may be vascular, neurogenic, psychogenic, endocrine or drug-related.
Phosphodiestrase 5 inhibitors such as sildenafil (Viagra) offer good short term treatment. Penile implants may be considered as long term treatment. If untreated, erectile dysfunction may increase the mortality by increasing vascular accidents such as myocardial infarction and cerebrovascular accidents.
Erectile dysfunction means an inability to achieve or sustain normal erection of the penis. In the younger age, the cause is usually psychogenic. In older individuals, an underlying disease may be present. Diabetes and high blood pressure often cause erectile dysfunction. Erectile dysfunction can be treated by the use of drugs or implants.