Erectile Dysfunction: From Diagnosis to Treatment

Abstract

Erectile dysfunction (ED) is inability to achieve and maintain erection for satisfactory sexual intercourse persistently. ED can be classified according to the etiological factors as organic, psychogenic and mixed. Endothelial dysfunction takes important role in the pathophysiologic mechanism of vascular ED as well as cardiovascular diseases so that they share similar risk factors. The diagnosis and evaluation of ED start with a comprehensive medical, psychosocial and sexual history. International Index of Erectile Function (IIEF-5, IIEF-15) and Sexual Health Inventory for Men (SHIM) can be used for the evaluation. Physical examination includes detailed urogenital examination, examination for neurologic system, cardiovascular system, endocrin system and general examination. Basic laboratory tests (biochemical tests including blood glucose, lipid profile, creatinine, blood urea nitrogen, electrolytes and hormonal profile including testosterone, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin (PRL), catecholamine, Thyroid-Stimulating Hormone (TSH), thyroid hormones) are used for both diagnosis and assessing the severity of ED. Specific diagnostic tests (psychologic evaluation, nocturnal penile tumescence, color duplex doppler ultrasonography, injection test, arteriography, cavernosometry, cavernosography, electromyography, pudendal nerve evoked potential, biopsy etc.) would be also necessary. Treatment of erectile dysfunction basically depends on the etiologic factors. Treatment options are lifestyle modifications, oral phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VED), extracorporeal shock wave therapy (ESWT), stem cell therapy (SCT) and platelet-rich plasma injection (PRP), intracavernosal injections (ICI), intrauretral agents, penile prosthesis implantation (PPI), vascular surgery and other options.KeywordsErectionErectile dysfunctionErectilePenile prosthesis