ASSESSMENT AND TREATMENT OF IMPOTENCE

Impotence is a common problem but is often neglected or inappropriately assessed and treated. Assessment should be focused toward causes of impotence that have specific treatments: psychogenic, drug induced, hormonal, and vascular. Specific treatments available are sexual counseling, medication adjustment, hormone therapy, and vascular surgery. When impotence is neuropathic, of mixed etiology and/or unresponsive to disease-specific treatments, therapy should be determined by patient preference. Options include vacuum erection devices, penile self-injection therapy, and penile prosthesis. There is less evidence supporting the use of yohimbine, topical nitrates, or minoxidil.