Erectile Dysfunction

Erectile dysfunction is the most common sexual problem in men.

Erectile dysfunction is the inability to achieve and maintain an erection of sufficient rigidity for satisfactory sexual intercourse.

Causes:

• Endocrine: hypogonadism, thyroid disease
  
• Vascular such as smoker, IHD, PVD and CVA patients
• Neurogenic: autonomic neuropathy such as diabetes
• Drugs such as beta blocker
• Psychogenic: such as depression and anxiety

Management:
History

• Presence of nocturnal emission and frequent satisfactory morning erections makes endocrine disease unlikely.
• Review past medical history and drug chart.
• Five - Item Version of the International Index of Erectile Function Questionnaire

http://www.medal.org/OnlineCalculators/ch16/ch16.09/ch16.09.07.php

Physical examination

• External genitalia examination
• Check for peripheral pulses.

Investigations

• Blood test: FBC, UE, LFT, PSA, morning total testosterone, gonadotrophins and prolactin level and thyroid function test.

Treatment:
Non-pharmacological - such as removal of offending drugs, cessation of smoking and Vaccum device.
Pharmacological -
Modify the reversible causes such as replacement of testosterone, treatment of thyroid disorder.
Drugs
First line - Phosphodiesterase inhibitor such as sildenafil, tadalafil and vardanefil. However, they are contraindicated in patients who use the nitrate therapy.
Second line - intracorporal injection of vasodilator such as alprostadil.