Erectile dysfunction (ED) is the inability to achieve sufficient penile erection for satisfactory sexual performance. 

Penis erections occur due to complex interactions of central, peripheral, hormonal, and vascular systems pathways. 

Sexual activity is affected due to biological, social, and psychological factors, thus it is difficult to determine as clinical cause. 

The duration of the dysfunction is specified as follows: 

Lifelong i.e. present since first sexual experience 

Acquired i.e. develops after a period of relative normal sexual functioning 

ED occurs in 50% men >40 years old. Penile artery classified into dorsal, bulbourethral, and cavernous arteries. 

Sexual dysfunction is common in both genders, includes complete ED in 10% of men unable to maintain an erection.  

A survey of adults between 18 to 59 years old found 10.4% of men unable to maintain an erection in recent years. 

Vascular changes that are related to age in corpora cavernosa arteries suggest a connection to similar changes in the body. 

Cavernosal smooth muscle is regulated by central and peripheral factors. 

Spinal cord injuries can disrupt the nerve pathways involved in erection. 

Penile nerves and endothelium modulators to release smooth muscle contraction in vessels. 

Venous leakage from penile tissues due to ineffective occlusion prevents erection that cause damage to corporal smooth muscle. 

The strong erection depends on penile health, nerve function, and blood supply. 

Erections are influenced due to organic, physiologic, and psychogenic factors. 

Criteria for ED as follows: 

Partner factors  

Relationship factors 

Individual vulnerability factors 

Cultural or religious factors 

Hazard ratio of 1.45 like risk from current smoking or family MI history. 

Patients shows higher risks of cardiovascular events, MI, and cerebrovascular events compared to those without ED. 

Men shows anxiety or depression in some cases. Erectile issues occur with lower urinary symptoms. 

Population-based study related to age group between 40 to 70 to higher mortality. 

• Assess a patient and gather the following information: 
• Medication of nonprescription drug history 
• Sexual history 
• Medical and surgical history 
• Psychological history 

• Cardiovascular Examination 
• Genitourinary Examination 
• Endocrine Examination 
• Neurological Examination 

Acute symptoms as: 

Trauma, sudden hormonal changes, medication side effects, or acute illness 

Gradual symptoms as: 

Chronic medical conditions, long-term medication use, lifestyle factors 

Bupropion treatment was effective in a trial in men with sexual dysfunction during maintenance therapy. 

Methadone for opioid replacement therapy is related to higher occurrence rates. 

Testosterone gels treat male hypogonadism with less peaks than injectable agents for daily use. 

Exogenous androgens suppress natural production that may stimulate prostate growth and activate latent cancer. 

Medicated Urethral System for Erections formulates alprostadil (PGE1) into small intraurethral suppository for insertion. 

Some men with venous leak may require a penile constriction device to sustain erection. 

Urology

Patient should eat a balanced diet including fruits, vegetables, whole grains, and lean proteins. 

Follow regular physical activity and strength training to improves cardiovascular health. 

Patient should completely quit smoking and heavy alcohol intake to maintain healthy lifestyle. 

Therapy/counselling enhances communication, intimacy, reduces stress to improves sexual activity. 

Proper awareness about ED should be provided and its related causes with management strategies. 

Appointments with a sexologist and preventing recurrence of disorder is an ongoing life-long effort. 

Urology

Sildenafil: 

It is most effective in men with mild-to-moderate condition. It should be taken empty stomach approximately 1 hour before sexual activity. 

Tadalafil: 

It is effective for mild-to-moderate conditions including both organic and psychogenic causes. It should be taken 30 min before sexual intercourse. 

Urology

Papaverine: 

It is a nonspecific PDE inhibitor that increases both intracellular cAMP and cGMP levels. 

Phentolamine: 

It blocks circulating epinephrine and norepinephrine to reduce hypertension. 

Urology

Testosterone: 

It maintains secondary sex characteristics in androgen-deficient males. Use of depot injections suggested to produce high levels of serum testosterone. 

Urology

Vascular surgeries performed to improve blood flow to the penis. 

Penile implants are surgically placed inside the penis to achieve an erection. 

Vacuum erection devices are a mechanical device use to create a vacuum around the penis to draw blood into the corpora cavernosa. 

Urology

In the initial assessment phase, evaluation of medical history, physical examination and laboratory test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of Phosphodiesterase-5 Enzyme Inhibitors, vasodilator, and androgens. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the sexologist are scheduled to check the improvement of patients along with treatment response.