Key concepts

Erectile dysfunction (ED) can be classified as organic, psychogenic, or mixed. Many patients may initially have organic dysfunction, but develop a psychogenic component as they cope with their inability to achieve an erection.

^^ In addition to a physical exam, a thorough medical, social, and medication history with emphasis on cardiac disease must be taken before starting any treatment for ED to assess for ability to safely perform sexual activity and to assess for possible drug interactions.

A wide range of treatment options is now available for men with ED. These include medical devices, pharmacologic treatments, lifestyle modifications, surgery, and psychotherapy.

'O' When determining the best treatment for an individual, the role of the clinician is to inform the patient and his partner of all available options while understanding his medical history, desires, and goals. The choice of treatment is primarily left up to the couple, but most often treatment is initiated with the least invasive option and then progresses to more invasive options if needed.

^ Vacuum erection devices (VEDs) and intracavernosal injections are highly effective for many patients, but side effects, lack of spontaneity, and fear of needles limit their widespread use as first-line therapy.

® Effectiveness of the three available phosphodiesterase (PDE) inhibitors is essentially comparable, but differences exist in duration of action and, to a small degree, incidence of side effects and drug interactions.

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels.

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