Erectile Dysfunction

 

Am Fam Physician. 2016 Nov 15;94(10):820-827.

  Patient information: See related handout on erectile dysfunction, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is common, affecting at least 12 million U.S. men. The five-question International Index of Erectile Function allows rapid clinical assessment of ED. The condition can be caused by vascular, neurologic, psychological, and hormonal factors. Common conditions related to ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment. Performance anxiety and relationship issues are common psychological causes. Medications and substance use can cause or exacerbate ED; antidepressants and tobacco use are the most common. ED is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome. Tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial lifestyle interventions. Oral phosphodiesterase-5 inhibitors are the first-line treatments for ED. Second-line treatments include alprostadil and vacuum devices. Surgically implanted penile prostheses are an option when other treatments have been ineffective. Counseling is recommended for men with psychogenic ED.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.1 ED becomes more common as men age (Figure 1).2 At least 12 million U.S. men 40 to 79 years of age have ED.3

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Current smoking is significantly associated with ED, and smoking cessation has a beneficial effect on the restoration of erectile function.

A

13, 14

Men with metabolic syndrome should be counseled to make lifestyle modifications to reduce the risk of cardiovascular events and ED.

B

33

Phosphodiesterase-5 inhibitors are the first-line treatment for ED.

A

57


ED = erectile dysfunction.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Current smoking is significantly associated with ED, and smoking cessation has a beneficial effect on the restoration of erectile function.

A

13, 14

Men with metabolic syndrome should be counseled to make lifestyle modifications to reduce the risk of cardiovascular events and ED.

B

33

Phosphodiesterase-5 inhibitors are the first-line treatment for ED.

A

57


ED = erectile dysfunction.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

View/Print Table

BEST PRACTICES IN UROLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.

American Urological Association


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN UROLOGY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.

American Urological Association


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

View/Print Figure

Figure 1.

The prevalence of erectile dysfunction increases with age.

Information from reference 2.


Figure 1.

The prevalence of erectile dysfunction increases with age.

Information from reference 2.

Diagnosis

The five-question International Index of Erectile Function (IIEF-5) allows rapid clinical assessment of ED and can measure the effectiveness of ED treatments (see http://www.aafp.org/afp/2010/0201/p305.html#afp20100201p305-t3). Other diagnostic options include a single-question self-assessment (Table 1)4 and the Brief Male Sexual Function Inventory.5

View/Print Table

Table 1.

Single-Question Assessment of Erectile Dysfunction

Impotence means not being able to get and keep an erection that is rigid enough for sa

The Authors

show all author info

KARL T. REW, MD, is an assistant professor in the Departments of Family Medicine and Urology at the University of Michigan Medical School, Ann Arbor....

JOEL J. HEIDELBAUGH, MD, FAAFP, FACG, is a professor in the Departments of Family Medicine and Urology at the University of Michigan Medical School.

Address correspondence to Karl T. Rew, MD, University of Michigan Medical School, 24 Frank Lloyd Wright Dr., Lobby H, Ann Arbor, MI 48105 (e-mail: karlr@med.umich.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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