Erectile Dysfunction

Question 1

What is erectile dysfunction?

Answer 1

The inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
(Symptom not a disease)

Question 2

What are the broad categories the causes of ED can be split into?

Answer 2

Organic
Psychogenic
Mixed

Question 3

What factors favour an organic cause of erectile dysfunction?

Answer 3

Gradual onset of symptoms
Lack of tumescence
Normal libido

Question 4

What factors favour a psychogenic cause of erectile dysfunction?

Answer 4

Sudden onset of symptoms
Decreased libido
Good quality spontaneous or self-stimulating erections
Major life events
Problems or changes in relationships
Previous psychological problems
History of premature ejaculation

Question 5

What are risk factors for ED?

Answer 5

Cardiovascular disease risk factors: obesity, DM, dyslipidaemia, metabolic syndrome, hypertension, smoking.
Alcohol use
Drugs: SSRIs, beta-blockers

(Cycling >3 hours a week, advice to stop)

Question 6

What are the investigations of ED?

Answer 6

10-year cardiovascular risk calculation (measure lipids and fasting glucose serum levels)
Free testosterone (9-11 am - if low, repeat along with FSH, LH and prolactin)
(Some advice universal measurement of testosterone)

Question 7

What is the management of ED?

Answer 7

PDE5 inhibitors (such as sildenafil, Viagra) - should be prescribed to all patients regardless.

Vaccum erection devices - first-line treatment in those who can’t/won’t take a PDE-5 inhibitors.