Erectile Dysfunction

About Erectile Dysfunction

Erectile dysfunction ED is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, affecting well over 100 million men worldwide. ED increases with age; in the Massachusetts Male Aging Study, some degree of ED was reported by roughly 40 percent of men at age 40 and 70 percent at age 70. Causes include vascular most common, similar to coronary artery disease, involving endothelial dysfunction and reduced penile blood flow, neurological spinal cord injury, diabetes, multiple sclerosis, Parkinsons, hormonal low testosterone, hyperprolactinemia, psychological depression, anxiety, performance anxiety, relationship issues, and medication induced SSRIs, beta blockers, thiazides, antiandrogens. Importantly, ED is often a marker of systemic vascular disease and may precede coronary artery disease by 2 to 5 years. Diagnosis involves medical and sexual history, physical examination, and limited laboratory testing testosterone, glucose, lipid panel. Questionnaires such as the IIEF International Index of Erectile Function and its short form SHIM quantify severity. Management includes addressing modifiable risk factors smoking cessation, weight loss, exercise, optimizing medications. First line pharmacotherapy is PDE5 inhibitors sildenafil Viagra, tadalafil Cialis, vardenafil Levitra, avanafil Stendra, which enhance nitric oxide mediated erections. They are contraindicated with nitrates. Second line options include alprostadil intraurethral pellet or intracavernosal injection. Penile implant surgery inflatable prosthesis provides excellent satisfaction rates for refractory cases.