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Upon completion of the chapter, the reader will be able to:

  1. Identify the structures of the male reproductive system and describe the normal physiology of a penile erection.

  2. Explain the pathophysiology of the different types of erectile dysfunction (ED).

  3. Recognize risk factors and medications associated with the development of ED.

  4. Identify the goals of therapy when treating ED.

  5. Define the essential components of history, physical examination, and laboratory data needed to evaluate the patient presenting with ED.

  6. Describe current nonpharmacologic and pharmacologic options for treating ED and determine an appropriate first-line therapy for a specific patient.

  7. Compare and contrast the benefits and risks for the current phosphodiesterase (PDE) inhibitors.

  8. Identify patients with significant cardiovascular risk and recommend an appropriate treatment approach for their ED.




  • Image not available. Erectile dysfunction (ED) can be classified as organic, psychogenic, or mixed. Many patients may initially have organic dysfunction, but develop a psychogenic component as they cope with their inability to achieve an erection.

  • Image not available. In addition to a physical exam, a thorough medical, social, and medication history with emphasis on cardiac disease must be taken before starting any treatment for ED to assess for ability to safely perform sexual activity and to assess for possible drug interactions.

  • Image not available. Treatment options for ED include medical devices, pharmacologic treatments, lifestyle modifications, surgery, and psychotherapy. Reversible causes of ED should be identified first and treated appropriately.

  • Image not available. When determining the best treatment for an individual, the role of the clinician is to inform the patient and his partner of all available options while understanding his medical history, desires, and goals. The choice of treatment is primarily left up to the couple, but most often treatment is initiated with the least invasive option and then progresses to more invasive options if needed.

  • Image not available. Vacuum erection devices (VEDs) and intracavernosal injections are highly effective for many patients, but side effects, lack of spontaneity, and fear of needles limit their widespread use as first-line therapies.

  • Image not available. Effectiveness of the three available phosphodiesterase (PDE) inhibitors is essentially comparable, but differences exist in duration of action, absorption with a fatty meal and, to a small degree, incidence of side effects and drug interactions.

  • Image not available. Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels.




Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse. The definition is very subjective due to differences in desired or needed rigidity in patients of different ages and in different types of relationships. ED is the most prominent sexual problem in men, and it can lead to lower quality of life and self-esteem.1 Patients may also develop libido or ejaculatory disorders, but these are not considered ED.




ED becomes increasingly frequent as men age. Few ...

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