Chou PS, Chou WP, Chen MC, Lai CL, Wen YC, et al. Dynamic penile peak systolic velocity predicts major adverse cardiovascular events in hypertensive patients with erectile dysfunction. The relaxation of penile smooth muscle is mediated mainly by nitric oxide, which activates the enzyme guanylate cyclase. Proper evaluation includes a careful history, physical examination, and evaluation for possible endocrine causes (eg, low testosterone, high prolactin levels). Seibel I, Poli De Figueiredo CE, Teloken C et al: For example, treatments for prostate disease may also cause ED.

A cavernosography is used with a dynamic infusion cavernosometry. Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives. An open-label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil citrate and apomorphine hydrochloride in men with erectile dysfunction. Nagao K, Ishii N, Kamidono S et al: The POTENT I randomized trial: Penile biothesiometry: Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra).

Effects of weight loss intervention on erectile function in older men with type 2 diabetes in the Look Ahead Trial. Carrier S, Brock G, Casey R et al: The smooth muscle relaxation during erection depends upon the promotion of Ca 2+ efflux from smooth muscle cells, as well as the sequestration of intracellular calcium in the sarcoplasmic reticulum ( Fig. )2020; Nov;22(5):

  • An open-label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men naive to phosphodiesterase 5 inhibitor therapy.
  • The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus.
  • Binding of serotonin to most of its receptor subtypes inhibits erection [ 14 - 16 ].

Erectile Dysfunction: AUA Guideline (2020)

Marks LS, Duda C, Dorey FJ et al: The diagnosis of erectile dysfunction begins with a private and thorough evaluation of the patient. Bacon CG, Mittleman MA, Kawachi I et al:

  • Efficacy of apomorphine and sildenafil in men with nonarteriogenic erectile dysfunction.
  • Venous outflow drops as the expanding cavernosal spaces compress the venous plexus and the larger veins passing through the tunica albuginea.

Erectile Dysfunction

Bulbocavernosus reflex: Int J Impot Res. Goldstein I, Tseng LJ, Creanga D et al: Am J Cardiol 2020; 115: If your doctor suspects you have one of these illnesses, they may recommend a urine test or urinalysis. Pharmacological management of erectile dysfunction. Vacuum constriction devices provide acceptable alternative therapy for patients who do not qualify for medical treatment. The cardiovascular examination should include assessment of vital signs (especially blood pressure and pulse) and signs of hypertensive or ischemic heart disease.

Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U.

Frequently Asked Questions

An accurate diagnosis is important because it helps doctors identify the most effective treatment for you. Once found, a contrast dye is injected in order to determine if there are any blockages in the penile arteries. Deyoung L, Chung E, Kovac JR et al:

When to see your GP

Efficacy and safety of oral sildenafil in the treatment of erectile dysfunction: Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health. These tests are only required in severe erectile dysfunction and are offered by specialist clinics. Morano S, Mandosi E, Fallarino M et al: Discontinuation or switching to alternative drugs, such as angiotensin-converting enzyme inhibitors or calcium channel blockers (eg, diltiazem, nifedipine, amlodipine), may reduce ED. 3 On arousal, parasympathetic activity triggers a series of events starting with the release of nitric oxide and ending with increased levels of the intracellular mediator cyclic guanosine monophosphate (cGMP). With this test, you wear a plastic, ring-like device around your penis at nighttime to test whether you have erections during your sleep. Mental health problems, physical problems, certain diseases and health conditions, certain prescription medicines, and lifestyle choices have all been linked to ED.

In some instances, this may be all the doctor needs to make an accurate diagnosis of ED and provide you with treatment options.

In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile implant, a penis pump, or vascular reconstructive surgery. The typical adult testis is 4. The effects of erectile dysfunction are wide-ranging. Bring someone with you to help you ask questions and remember what your provider tells you. Giuliano F, Donatucci C, Montorsi F et al:

The newer angiotensin II receptor antagonists may be less problematic with respect to ED, but long-term data is needed to evaluate this.

How Is Erectile Dysfunction Diagnosed?

2020; Dec;44(6): Martin-Morales A, Meijide F, Garcia N et al: Erectile dysfunction in essential arterial hypertension and effects of sildenafil: Birthi P, Nagar VR, Nickerson R et al: Is there any new curve or bend to your penis to suggest Peyronie’s disease? If you’ve experienced erection problems, you’re not alone.


These are often used to treat ED. A comparative review of the options for treatment of erectile dysfunction: DeBusk RF, Pepine CJ, Glasser DB et al: Single-phase flow with minimal or absent diastole when the penis is flaccid. Can J Urol 2020; 11:

6, 18–19 Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex. J Androl 2020; 23: Porst H, Sharlip ID, Hatzichristou D et al: Why it won’t work right In men with heart disease, the vessels that send blood to the penis can get clogged, just as other blood vessels can. Linet OI, Ogrinc FG. Russo D, Musone D, Alteri V et al: Jain P, Rademaker AW, McVary KT. The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis.

  • If and how much do you smoke, drink, or use other drugs?
  • You’re able to get an erection, but you cannot maintain it long enough to have sex.
  • A multicenter, randomized, double-blind, crossover study to evaluate patient preference between tadalafil and sildenafil.
  • Which is first?
  • The CNS integrates and coordinates incoming sensory information from the visual and auditory systems (via the occipital cortex) and cognitive/imaginative stimuli (via the limbic systems), along with tactile and olfactory sensory information (via the thalamus and rhinencephalon, respectively) [ 8 ].
  • Not only is it readily available, but it is minimally invasive and can be well tolerated by patients.

Risk Factors For Erectile Dysfunction

Zhao C, Kim SW, Yang DY et al: The term erectile dysfunction is not used for other disorders of erection, such as priapism. The first sign of erectile dysfunction is often a consistent inability to maintain an erection until orgasm. Efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of male erectile dysfunction in Colombia, Ecuador, and Venezuela: 30 However, satisfaction with this treatment modality typically wanes with time, as patients report dissatisfaction with how cumbersome or unnatural the devices are to use, hinging or buckling of the erection with thrusting, and dissatisfaction with the fact that the erection is ischemic and therefore cold, which can be off-putting to the partner.

ED itself is often related to an underlying problem such as heart disease, diabetes, liver disease, or other health conditions. Dynamic infusion cavernosometry (DICC) technique in which fluid is pumped into the penis at a known rate and pressure. Gonzalez RR and Kaplan SA: This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous. Peyronie's disease, which is an inflammatory condition that produces scarring within the penis, causing it to curve or bend, can also contribute to ED. When an erection stops, it’s because of the contraction of muscles in the penis. J Urol 2020; 178: These are a group of muscles around the underside of the bladder and rectum, as well as at the base of the penis.

This is used to measure the blood flow in the penis. Early intervention with phosphodiesterase-5 inhibitors after prostate brachytherapy improves subsequent erectile function. If it’s been a while since you’ve seen a doctor, they may choose to run some basic blood work such as a complete blood count (CBC) and a comprehensive metabolic panel (CMP). Diagnosis and management of male sexual dysfunction. Asking questions about your history of erectile dysfunction can help your provider find out whether your problems are with sexual desire, erection, ejaculation, or orgasm (climax). Your health care provider may also suggest treating emotional problems. If you suspect ED, you may want to see a doctor to confirm.

Causes of Condition

It is important to emphasize to patients that these drugs augment the body’s natural erectile mechanisms, therefore the neural and psychoemotional stimuli typically needed for arousal still need to be activated for the drugs to be efficacious. J Androl 2020; 33: Avanafil for male erectile dysfunction:

The complete inability to achieve an erection. Padma-Nathan H, McMurray JG, Pullman WE et al: Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Help is available. If no nocturnal erection occurs, or if the erection is impaired, the causes of Erectile dysfunction are likely to be physical. Belkoff LH, McCullough A, Goldstein I et al: 17 If the initial testosterone level is low, follow-up studies should include luteinizing hormone and follicle-stimulating hormone levels to differentiate testicular from hypothalamic-pituitary dysfunction. Kirby M, Creanga DL and Stecher VJ:

Zelefsky MJ, Shasha D, Branco RD et al: A blood test can reveal issues beyond problems attaining or sustaining an erection. 9 million adult men in the U. What is erectile dysfunction? Physical examination. Asian J Androl 2020; 13: Microscopic penile revascularization.

Erectile Dysfunction Treatment: Oral Drugs

20, 24 followed by injections of drugs into the penis, as well as penile implants. This drug has a similar chemical structure to sildenafil citrate and works in a similar manner. It is not the situation itself that is making you unhappy, but how you think about it and react to it. Efficacy and safety of on-demand oral tadalafil in the treatment of men with erectile dysfunction in Taiwan: Many entities with a strong relationship to ED also diminish bioavailable testosterone, including obesity, diabetes, and opioid use. Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: Comparing effects of low- and high-volume moderate-intensity exercise on sexual function and testosterone in obese men.

Role of androgens in erectile function.

Effect of Levitra on sustenance of erection (EROS): 1995; Jun;64(3): Long-term potency after iodine-125 radiotherapy for prostate cancer and role of sildenafil citrate. In making a diagnosis of erectile dysfunction (ED), your doctor will start by taking a detailed medical and psychosexual history and conducting a thorough physical examination. The process involves premature and unusually severe hardening of the arteries.

Mental Health Exam

Men typically have three to five erections while sleeping, and if you aren’t, it may be due to a health condition or medication that decreases blood flow to the penis or interferes with nerve signals that enable arousal and erection. Saigal CS, Wessells H, Pace J et al: This drug works best when taken on an empty stomach and many men can get an erection 30 to 60 minutes after taking the medication. Contemporary management of impotence and infertility. Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. The worldwide prevalence and epidemiology of erectile dysfunction. Be prepared for questions such as these:

Secondary sex characteristics.

Glina S, Damiao R, Abdo C et al: Although the condition is called venous leak, the real problem is not with the veins but malfunction of the smooth muscle that surrounds the veins. These products are especially dangerous for men who take nitrates. Benet AE, Melman A. Vardenafil demonstrates first-dose success and reliability of penetration and maintenance of erection in men with erectile dysfunction - RELY-II. Early use of a phosphodiesterase inhibitor after brachytherapy restores and preserves erectile function. Giuliano F, Montorsi F, Mirone V et al: Discuss what your doctor hopes to gather from this information.

[20][21] Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.

Erection can be induced by injecting 10-20 µg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25-30 min (see image). You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT). What to do when diabetes affects your sex life – health essentials from cleveland clinic. In many cases, ED is rooted in psychological issues — especially in men under 40 years of age. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and chronic heart failure. Patel HR, Ilo D, Shah N et al: Maiorino MI, Bellastella G, Caputo M, Castaldo F, Improta MR, Giugliano D, et al.

Korean J Urol 2020; 54:
For example, your doctor might ask you not to eat before having a blood test.

Sexual History

Pelvic surgery may disrupt both neural and vascular pathways, resulting in ED. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Treatment for ED is based on the cause of the problem. Did you experience any side effects from the medications?

Several reflexes can be tested to evaluate sacral cord function. A patient's medical history and recent physical and emotional changes will play an important role in diagnosing erectile dysfunction (ED). Int J Clin Pract 2020; 66:

Drug Basics & Safety

In general, are you under a lot of stress? Efficacy, safety and patient acceptance of sildenafil citrate as treatment for erectile dysfunction. Communicate openly and honestly about your condition. BJU Int 2020; 109: Wang H, Yuan J, Hu X et al:

A multicenter, double-blind, placebo-controlled trial to assess the efficacy of sildenafil citrate in men with unrecognized erectile dysfunction. Levinson IP, Khalaf IM, Shaeer KZ et al: Zippe CD, Jhaveri FM, Klein EA et al:

Loss Of Interest In Sexual Activity

Wing RR, Rosen RC, Fava JL et al: 26 Some sources show that vascular reconstructive surgeries are viable options for some people. Efficacy of sildenafil in male dialysis patients with erectile dysfunction unresponsive to erythropoietin and/or testosterone treatments. Pahlajani G, Raina R, Jones JS et al: Evaluation of young men with organic erectile dysfunction. Continuation and effectiveness of tadalafil once daily during a 6-month observational study in erectile dysfunction: Their absence may indicate a problem with nerve function or blood supply in the penis.

This test is usually performed by a specialist in an office. This testing is performed by a radiologist who places a small tube in the femoral artery in the upper thigh, then finds the artery that goes to the penis. Cathala N, Mombet A, Sanchez-Salas R et al:

Everyday Health Men's Health Erectile Dysfunction

Is this a major issue between you? The enzyme phosphodiesterase‐5 degrades cGMP, leading to penile smooth muscle contraction and detumescence [ 20 ]. If you have erections, how firm are they? Keep reading to learn about treatment options.

Hoffmann TC and Del Mar C: Fluid is pumped into the penis and measured, so doctors can assess the severity of the leak. You should talk to your doctor if you’re experiencing persistent ED or associated symptoms. Clinical studies have suggested that these devices are effective and acceptable to a large number of patients with ED of varying causes, including psychogenic erectile failure. Oral sildenafil in the treatment of erectile dysfunction. What are the frequency, quality and duration of any erections you have had? This test can determine if you have blood flow problems. Urology 2020; 83:

Either way, low T can result in reduced sex drive, depression, and weight gain.

Diagnosis Of Erectile Dysfunction

Physical exam. Lamina S, Okoye CG and Dagogo TT: Switching patients with erectile dysfunction from sildenafil citrate to tadalafil: Do you have morning or evening erections and, if so, what is the quality of these erections? Study data suggests it affects 18 million men over the age of 20 in the United States. Stress management and erectile dysfunction:

Common Conditions

Men with erectile dysfunction and their partners often lack a full understanding of sexual processes or have unrealistic expectations regarding sexual performance and satisfaction. Park HJ, Park NC, Shim HB et al: Sildenafil citrate (Viagra) improves erectile function in elderly patients with erectile dysfunction: If your doctor thinks there’s a psychological cause, he might refer you to a mental health professional. Efficacy of sildenafil in an open-label study as a continuation of a double-blind study in the treatment of erectile dysfunction after radiotherapy for prostate cancer. Rod implants. Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Gans WH, Zaslau S, Wheeler S et al:

Psychological and interpersonal correlates in men with erectile dysfunction and their partners: Loran OB, Stroberg P, Lee SW et al: J Urol 2020; 167: Occasional, or intermittent, sexual problems don't necessarily point to erectile dysfunction. Generally performed by a specialist, an ultrasound is a simple procedure that can help identify any blood flow issues to your penis.

Standard operating procedures for taking a sexual history. Erectile dysfunction: how porn, bike riding, alcohol and ill-health contribute to it, and six ways to maintain peak performance. 50 mg for erectile dysfunction. Discuss your symptoms and concerns with your doctor to help figure out the cause of your erectile dysfunction. Nightly vs on-demand sildenafil for penile rehabilitation after minimally invasive nerve-sparing radical prostatectomy: It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care. Heruti R, Shochat T, Tekes-Manova D, Ashkenazi I, Justo D. Because there are a variety of causes for ED, there are several different tests your doctor may use to diagnose the condition and determine its cause.

Neurogenic Conditions

The COBRA trial. Li G, Lan H, Liang J et al: High-flow priapism: If your partner is pregnant, use a condom during sex if you are inserting alprostadil into your urethra.

Dinsmore WW, Hodges M, Hargreaves C et al: What is Your Next Step? Reviewing your sexual activity can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation. Its causes vary, which means you may need to develop a multi-pronged approach to your treatment plan. The temporal relationship between erectile dysfunction and cardiovascular disease. The foods that help set the mood and improve erectile dysfunction. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. You then place a rubber ring around the base of the penis to maintain the erection. Rosen RC, Allen KR, Ni X et al:

The New AUAnet

Your partner might see your inability to have an erection as a sign of diminished sexual interest. Am J Mens Health 2020; 9: Oral sildenafil in the treatment of erectile dysfunction in diabetic men: J Sex Med 2020; 2: Data from references 20-23.

Meuleman E, Cuzin B, Opsomer RJ et al: Prescription medicines injected into the penis or put into the urethra. Increased understanding of the male erectile process and the development of several agents to improve erectile function have generated great public interest among men and their sexual partners. What medications or drugs are you currently using? This test evaluates nerve sensation in the penis.

Do you have any psychological illnesses or have you considered seeing a psychologist? A patient will either go home on the same day or spend one night in the hospital. What are other possible causes? Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al.