TOC |  Kidney
Erectile Dysfunctions (ED)            REF: PIER ACP Online 2005  |  ED2007.pdf  

Determine the severity of ED as being mild, moderate, or severe/complete:

Categorize the cause according to whether there is

History and Physical Examination Elements for Erectile Dysfunction


  1. ED history - Inquire about onset, duration, evolution, severity, cause, stimulus required for achievable erections; simple, patient-administered, validated questionnaires recently have been developed for easy use by physicians in clinical settings (4; 8)
  2. Cardiovascular disorders  - Look for hypertension, hyperlipidemia, diabetes mellitus, atherosclerosis, peripheral vascular disease, and cigarette use
  3. Neurogenic disorders  - Look for diabetes mellitus, cerebrovascular accidents, Parkinson's disease, and multiple sclerosis
  4. Endocrine disorders - Look for hypogonadism, hyperprolactinemia, hyperthyroidism, and hypothyroidism
  5. Penile disorders - Peyronie's disease, priapism
  6. Injuries  - Particularly perineal, pelvic, or nervous system trauma and radiation or surgery to the pelvis or retroperitoneum
  7. Psychosocial elements - Ask about potential stresses, interpersonal relationship problems, and affective disorders
  8. Medications - Look for antihypertensives, antidepressants, antiandrogens, and NSAIDs. (See table Medication Associated in the Literature with Erectile Dysfunction). Medications are estimated to play a role in up to 25% of cases of ED (10)
  9. Substances of abuse - Ask about alcohol, tobacco, and recreational drugs; drugs like cocaine, opiates, and marijuana have CNS depressant effects and vasoconstrictor actions that can decrease local blood flow to the penis

Physical exam

  1. Height and weight - May be helpful in identifying congenital disorders that may be accompanied by ED
  2. BP - Looking for hypertension as a risk factor for vascular disease
  3. Vascular exam - Palpate femoral and pedal pulses to look for evidence of vascular disease
  4. Neurological exam - Evaluate genital and perineal sensation and bulbocavernosus reflex
  5. Endocrine exam - Evaluate thyroid gland for masses or other abnormalities, breasts for gynecomastia, general masculine development, and hair distribution
  6. Genital exam - Look for penile deformities, such as micropenis, chordee, and Peyronie's disease (fibrous plaques in the corpora cavernosa); evaluate position, size, and consistency of the testes
  7. Prostate exam - Evaluate size, consistency, and presence of nodules or induration; this portion of the exam is performed as needed based on the patient's age and relative risk status for prostate disease (e.g., prostate cancer) that might be stimulated by exogenously administered testosterone

Medications Associated with Erectile Dysfunciton

Republished with permission from Meinhardt W, Kropman RF, Vermeij P, Lycklama A, Nijehold AAB, and Zaartendiijk J. The influence of medication on erectile function. Int J Impot Res. 1997;9:17-26.

Laboratory and Other Studies for Erectile Dysfunction

  1. Serum chemistries  - May be useful in confirming clinical suspicion of underlying chronic diseases (e.g., diabetes, renal insufficiency, liver disease)
  2. CBC - May be useful in confirming clinical suspicion of underlying chronic disease
  3. Testosterone (total) - A fasting morning level is recommended to screen androgenic status;
    if the level is low (suspected of hypogonadism), measure serum free (or bioavailable) testosterone, prolactin, and leuteinizing hormone (LH);
    If the prolactin level is elevated and/or the LH level is not elevated, then Brain MRI should be obtained to rule out a pituitary adenoma.
  4. Thyroid function tests - To confirm clinical suspicion of thyroid dysfunction, which may underlie ED
  5. Lipid profile - Looking for hyperlipidemia in suspected cardiovascular disease
  6. PSA - Serum PSA testing is performed as needed if prostate pathology is suspected, which may be stimulated by exogenously administered testosterone
  7. Urinalysis - Dipstick analysis may reveal glucosuria, suggesting diabetes mellitus


Non drug therapy: Offer psychosexual therapy or counseling (optimally, for the patient and his partner) for both organic and psychogenic presentations of dysfunction.

Drug Treatment for Erectile Dysfunction

Sildenafil citrate (Viagra)

Vardenafil hydrochloride (Levitra)

Tadalafil (Cialis)

Alprostadil (MUSE) Prostaglandin E1

Alprostadil (Prostin VR, Caverject, Edex)  Prostaglandin E1  

Testosterone Replacement  

Drug therapy for Premature Ejaculation:

Consider Prazac (Fluoxetine) 10-40 mg/d, max 80 mg/d, Paxil (Paroxetine) 10-40 mg/d, max 50 mg/d, Dapoxetine ?