++
+++
Essentials of Diagnosis
++
Erectile dysfunction can have organic and psychogenic etiologies and the two frequently overlap
Organic erectile dysfunction may be an early sign of cardiovascular disease and requires evaluation
Peyronie disease is a common benign fibrotic disorder of the penis that causes pain, penile deformity, and sexual dysfunction
+++
General Considerations
++
Consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse
Erectile dysfunction occurs from arterial, venous, neurogenic, or psychogenic causes
Most common cause of erectile dysfunction is a decrease in arterial flow resulting from progressive vascular disease
Loss of orgasm: if libido and erections are intact, usually of psychological origin
Premature ejaculation
Priapism is the occurrence of penile erection unrelated to sexual stimulation, generally lasting longer than 4 hours
Causes ischemic injury of the corpora cavernosa and erectile dysfunction (low flow or "ischemic" priapism); ischemic priapism requires immediate intervention to avoid irreversible penile damage
Can be due to unregulated high blood flow
May be caused by red blood cell dyscrasias, drug use, and any of the treatments for erectile dysfunction
Loss of seminal emission may result from androgen deficiency by decreasing prostate and seminal vesicle secretions as well as sympathetic denervation as a result of spinal cord injury, diabetes mellitus, or pelvic or retroperitoneal surgery
Retrograde ejaculation may occur as a result of mechanical disruption of the bladder neck due to congenital abnormalities, transurethral prostate surgery, pelvic radiation, treatment with alpha-blockers, or sympathetic denervation
++
More than half of men aged 40–70 years have erectile dysfunction
Peyronie disease primarily affects men aged 45–60 years, with average age at onset of 53 years
Almost all patients with Peyronie disease are Caucasians (especially in those of northern European or Scandinavian heritage)
It is much less common to rare in men of African heritage (unless diabetic), and rare to unknown in men of Asian heritage
++
History: erectile dysfunction should be distinguished from problems with penile deformity, libido, orgasm, and ejaculation
Histories of prostate cancer treatment or Peyronie disease should be elicited
Degree of the dysfunction—chronic, occasional, or situational
Timing of dysfunction
Determine whether the patient ever has any normal erections, such as in early morning or during sleep
Inquire about dyslipidemia, hypertension, neurologic disease, diabetes mellitus, chronic kidney disease, endocrine disorders, depression, and cardiac or peripheral vascular disease
Trauma to the pelvis, pelvic or prostate irradiation, or peripheral vascular surgery
Use of drugs, alcohol, tobacco, and recreational drugs
Physical examination of genitalia, testicles, and prostate