ERECTILE DYSFUNCTION (ED)






penile erection


Reference [4]
Age
(years)
% of population reporting ED
< 40 1 - 10%
40 - 49 2 - 15%
50 - 59 6 - 35%
60 - 69 20 - 40%
≥ 70 50 - 100%




  • References [1,2,3,10]
NEUROLOGICAL
Causes Risk factors
Central nervous system
dysfunction
  • Multiple sclerosis
  • Spinal cord injury
  • Stroke
  • Parkinson disease
  • Alzheimer's
Peripheral nervous system
dysfunction
  • Diabetic neuropathy
  • Peripheral neuropathy
  • History of pelvic irradiation
    or surgery
  • Prostatectomy - occurs in 25 - 75%
    of men after surgery
VASCULAR
Causes Risk factors
Endothelial dysfunction
(decreased nitric oxide release)
  • Advancing age
  • Atherosclerosis
  • High cholesterol
  • Diabetes
  • Hypertension
  • Obesity
  • Sedentary lifestyle
  • Benign prostatic hypertrophy
  • Smoking
PSYCHOLOGICAL
Causes Risk factors
Past issues
  • History of trauma
  • History of sexual abuse
  • Strict upbringing
  • Guilt
Current issues
  • Depression
  • Anxiety
  • Relationship problems
  • Major life event - childbirth, job loss, etc.
ENDOCRINOLOGICAL
Hypogonadism (low testosterone)
Hyperprolactinemia
Hyper- and hypocortisolism
(Cushing's disease, Addison's disease)
Hypothyroidism
Diabetes
OTHER
Peyronie's disease
Hypospadias, epispadias
Cavernous fibrosis
Alcohol abuse
Illicit drug use (ex. cocaine, THC,
amphetamines)




Reference [1,2,3,10]
MEDICATIONS ASSOCIATED WITH ED
Drug class Medication examples
Antiandrogens
  • Finasteride (Proscar®, Propecia®)
  • Flutamide
  • GnRH agonists - leuprorelin, triptorelin, goserelin
  • Ketoconazole
  • Spironolactone
  • H₂ blockers (famotidine, cimetidine, etc.)
Anticholinergic medications
Antidepressants
  • SSRIs (fluoxetine, paroxetine, etc.)
  • SNRIs (venlafaxine, etc.)
  • Tricyclic (amitriptyline, etc.)
Blood pressure
medications
Butyrophenones
  • Haloperidol (Haldol®)
  • Droperidol
  • Domperidone
Cholesterol
medications
Cytotoxic
medications
Heart
medications
  • Amiodarone (Cordarone®)
  • Digoxin
  • Disopyramide
Interferon
  • PegIntron®
  • Pegasys®
Phenothiazines
  • Promethazine
  • Prochlorperazine
  • Thioridazine
Steroids




Finding Considerations
Patient reports rigid erections in the morning, nighttime, or during sexual thoughts
  • Probable psychogenic ED
ED has sudden onset or is intermittent
  • Probable psychogenic ED
Patient reports lower urinary tract symptoms
  • Consider BPH
  • Examine prostate
  • PSA when indicated
Risk factors for vascular disease
  • Check lipid profile
  • Screen for diabetes
  • Measure blood pressure
Hypothyroid symptoms
  • Measure TSH
Low testosterone symptoms