Erectile dysfunction can result from organic, psychogenic, or substance-induced causes. Phosphodiesterase type 5 inhibitors are the mainstay of medical treatment, although other medications and interventions, such as intracavernosal injection therapy and constriction devices, can also be used. Priapism is defined as a prolonged erection of the penis continuing after or irrespective of sexual stimulation. It may result from conditions causing ischemic states or dysregulation of arterial inflow. Acute ischemic priapism is a medical emergency and can result in irreversible erectile dysfunction. Nonischemic priapism is not an emergent condition and should resolve spontaneously. Phimosis, or inability to fully retract the penile prepuce over the glans, is a congenital or acquired condition and can cause discomfort. Physiologic phimosis usually resolves by age 16 years, whereas pathologic phimosis may require circumcision for definitive treatment. Paraphimosis, an emergent condition, results from the foreskin becoming trapped proximal to the coronal sulcus. Treatment consists of manual reduction. In Peyronie disease, fibrous plaques develop in the penile shaft, subsequently causing deformity of the penis when erect. Surgical and nonsurgical treatment options, such as collagenase or intralesional injections, are available.

Case 2. VK is a 19-year-old foreign exchange student. He reports that since starting college, he has experimented with alcohol and nicotine vapes and, more recently, has become sexually active. He says he felt embarrassed when one of his partners commented that most American men are circumcised, as this practice is uncommon in his home country. Since then, he has had difficulty achieving an erection with another person present. He denies pain or difficulty with erection or ejaculation when masturbating. A chaperoned physical examination reveals a tight foreskin hood that does not easily retract over the glans but is otherwise unremarkable.