Erectile dysfunction is the ongoing inability to get or keep an erection firm enough for satisfying sex. Most cases have a vascular cause linked to diabetes, high blood pressure, smoking and high cholesterol, so it can be an early warning sign of heart disease.
Key symptoms
- Trouble getting or keeping an erection
- Lower sexual desire if testosterone is low
- Loss of morning erections in physical causes
- Stress, low mood or relationship strain
What you find on exam
- Blood pressure, weight and waist size
- Genital exam: testis size, penile plaques (Peyronie disease)
- Peripheral pulses and signs of vascular disease
- Signs of low testosterone: less body hair, breast enlargement
Tests
- Fasting glucose or HbA1c and lipid panel
- Morning total testosterone
- Cardiovascular risk assessment
- Thyroid tests or prolactin if the history suggests it
Treatment basics
- Lifestyle: exercise, weight loss, stop smoking, less alcohol
- PDE5 inhibitor such as sildenafil or tadalafil
- Review medicines that can cause erectile dysfunction
- Vacuum device, injections or penile implant if pills fail
- Counseling for psychological factors
Red flags
- Nitrate use: PDE5 inhibitors are contraindicated
- Erection lasting more than 4 hours (priapism)
- Chest pain during sexual activity
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.