ERECTILE DYSFUNCTION

Erectile dysfunction is the inability to maintain an erect penis with sufficient rigidity for vaginal penetration and sexual satisfaction. It is different from loss of libido, premature ejaculation, or absence of orgasm. It is an age-dependent disorder with an incidence of 1.9% at 40 years and up to 25% at 65 years.(15) Moreover, certain diseases such as diabetes mellitus predispose the patient to erectile dysfunction with reported incidence as high as 50%.(24) Innovative laboratory and clinical research in the hemodynamics, neurophysiology, and pharmacology of erection have greatly improved our understanding of the pathophysiology of erectile dysfunction. To date, organic erectile dysfunction has been most frequently attributed to neurogenic and vasculogenic abnormalities. In most of the cases, however, the etiology of the disease is complex and involves more than one cause. Because intracavernous injection therapy, in which the medication is injected directly into the corpus cavernosum, is successful in most patients regardless of the cause of the impotence, the physician is often placed in the position of treating the symptom while overlooking the cause of erectile dysfunction. We believe that a basic workup including a detailed history, physical examination, and blood tests should be obtained in every patient. Additional tests can then be individualized according to the patient's general health, expectations, and goal. This article provides an overview of our approach.