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Current Diagnosis and Management of Erectile Dysfunction

  • MALE SEXUAL DYSFUNCTION AND DISORDERS (M KHERA AND SE ALTHOF, SECTION EDITORS)
  • Published:
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Abstract

Erectile dysfunction (ED) affects a growing number of men in the USA and abroad, with significant impacts on sexual function and overall quality of life. The risk factors for ED are numerous and include a strong link to cardiovascular disease, such that men with ED should be screened for cardiovascular disease. The evaluation of men presenting with ED includes a comprehensive history and physical exam to aid in the identification of comorbidities as well as laboratory testing to evaluate hormone and lipid levels and sugar metabolism. Adjunct studies are also available, though their utility is often limited to specific subtypes of ED. Once the etiology of ED is established, treatment can be initiated using appropriate medical therapies, including phosphodiesterase type 5 (PDE5) inhibitors, and transurethral or intracavernosal therapies, with surgical intervention via revascularization or penile prosthesis placement in men demonstrating a lack of response to medical therapy. In all cases of ED, a psychogenic component is present and referral for psychological intervention with or without medical therapy should be considered.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hyde Z, Flicker L, Hankey GJ, Almeida OP, McCaul KA, Chubb SA, et al. Prevalence of sexual activity and associated factors in men aged 75 to 95 years: a cohort study. Ann Intern Med. 2010;153(11):693–702.

    PubMed  Google Scholar 

  2. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res. 2000;12(6):305–11.

    CAS  PubMed  Google Scholar 

  3. Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Beckman N, Waern M, Ostling S, Sundh V, Skoog I. Determinants of Sexual Activity in Four Birth Cohorts of Swedish 70-year-olds Examined 1971–2001. J Sex Med. 2014;11:401–10.

    PubMed  Google Scholar 

  5. Perelman MA. Sex coaching for physicians: combination treatment for patient and partner. Int J Impot Res. 2003;15 Suppl 5:S67–74.

    PubMed  Google Scholar 

  6. Mykletun A, Dahl AA, O’Leary MP, Fossa SD. Assessment of male sexual function by the Brief Sexual Function Inventory. BJU Int. 2006;97(2):316–23.

    PubMed  Google Scholar 

  7. O’Leary MP, Rhodes T, Girman CJ, Jacobson DJ, Roberts RO, Lieber MM, et al. Distribution of the Brief Male Sexual Inventory in community men. Int J Impot Res. 2003;15(3):185–91.

    PubMed  Google Scholar 

  8. Panser LA, Rhodes T, Girman CJ, Guess HA, Chute CG, Oesterling JE, et al. Sexual function of men ages 40 to 79 years: the Olmsted County study of urinary symptoms and health status among men. J Am Geriatr Soc. 1995;43(10):1107–11.

    CAS  PubMed  Google Scholar 

  9. Muller MJ, Ruof J, Graf-Morgenstern M, Porst H, Benkert O. Quality of partnership in patients with erectile dysfunction after sildenafil treatment. Pharmacopsychiatry. 2001;34(3):91–5.

    CAS  PubMed  Google Scholar 

  10. Litwin MS, Nied RJ, Dhanani N. Health-related quality of life in men with erectile dysfunction. J Gen Intern Med. 1998;13(3):159–66.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology. 1998;52(5):848–52.

    CAS  PubMed  Google Scholar 

  12. Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: the female experience of men’s attitudes to life events and sexuality (FEMALES) study. J Sex Med. 2005;2(5):675–84.

    PubMed  Google Scholar 

  13. Oberg K, Sjogren Fugl-Meyer K. On Swedish women’s distressing sexual dysfunctions: some concomitant conditions and life satisfaction. J Sex Med. 2005;2(2):169–80.

    PubMed  Google Scholar 

  14. Tsertsvadze A, Yazdi F, Fink HA, et al. Diagnosis and treatment of erectile dysfunction, Rockville: Agency for Healthcare Research and Quality (US); 2009. vol. 171.

  15. Shabsigh R, Kaufman JM, Steidle C, Padma-Nathan H. Randomized study of testosterone gel as adjunctive therapy to sildenafil in hypogonadal men with erectile dysfunction who do not respond to sildenafil alone. J Urol. 2004;172(2):658–63.

    CAS  PubMed  Google Scholar 

  16. Lin CS, Lin G, Lue TF. Cyclic nucleotide signaling in cavernous smooth muscle. J Sex Med. 2005;2(4):478–91.

    CAS  PubMed  Google Scholar 

  17. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342(24):1802–13.

    CAS  PubMed  Google Scholar 

  18. Jin L, Burnett AL. RhoA/Rho-kinase in erectile tissue: mechanisms of disease and therapeutic insights. Clin Sci. 2006;110(2):153–65.

    CAS  PubMed  Google Scholar 

  19. No Authors. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993; 270(1):83–90.

  20. Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med. 2007;120(2):151–7.

    PubMed  Google Scholar 

  21. Guo W, Liao C, Zou Y, Li F, Li T, Zhou Q, et al. Erectile dysfunction and risk of clinical cardiovascular events: a meta-analysis of seven cohort studies. J Sex Med. 2010;7(8):2805–16.

    PubMed  Google Scholar 

  22. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996–3002.

    CAS  PubMed  Google Scholar 

  23. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010;64(7):848–57.

    CAS  PubMed  Google Scholar 

  24. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27(22):2632–9.

    PubMed  Google Scholar 

  25. Polonsky TS, Taillon LA, Sheth H, Min JK, Archer SL, Ward RP. The association between erectile dysfunction and peripheral arterial disease as determined by screening ankle-brachial index testing. Atherosclerosis. 2009;207(2):440–4.

    CAS  PubMed  Google Scholar 

  26. Ponholzer A, Temml C, Obermayr R, Wehrberger C, Madersbacher S. Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol. 2005;48(3):512–8. Discussion 517–518.

    PubMed  Google Scholar 

  27. Blanker MH, Bohnen AM, Groeneveld FP, Bernsen RM, Prins A, Thomas S, et al. Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study. J Am Geriatr Soc. 2001;49(4):436–42.

    CAS  PubMed  Google Scholar 

  28. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161–8.

    PubMed  Google Scholar 

  29. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med. 2000;30(4):328–38.

    CAS  PubMed  Google Scholar 

  30. Esposito K, Giugliano D. Obesity, the metabolic syndrome, and sexual dysfunction. Int J Impot Res. 2005;17(5):391–8.

    CAS  PubMed  Google Scholar 

  31. Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978–84.

    CAS  PubMed  Google Scholar 

  32. Isidori AM, Buvat J, Corona G, Goldstein I, Jannini EA, Lenzi A, et al. A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment—a systematic review. Eur Urol. 2014;65:99–112.

    CAS  PubMed  Google Scholar 

  33. Chughtai B, Lee RK, Te AE, Kaplan SA. Metabolic syndrome and sexual dysfunction. Curr Opin Urol. 2011;21(6):514–8.

    PubMed  Google Scholar 

  34. Gore J, Rajfer J. The role of serum testosterone testing: routine hormone analysis is an essential part of the initial screening of men with erectile dysfunction. Rev Urol. 2004;6(4):207–10.

    PubMed Central  PubMed  Google Scholar 

  35. Shabsigh R. Testosterone therapy in erectile dysfunction and hypogonadism. J Sex Med. 2005;2(6):785–92.

    CAS  PubMed  Google Scholar 

  36. Blute M, Hakimian P, Kashanian J, Shteynshluyger A, Lee M, Shabsigh R. Erectile dysfunction and testosterone deficiency. Front Horm Res. 2009;37:108–22.

    CAS  PubMed  Google Scholar 

  37. Buvat J, Maggi M, Gooren L, Guay AT, Kaufman J, Morgentaler A, et al. Endocrine aspects of male sexual dysfunctions. J Sex Med. 2010;7(4 Pt 2):1627–56.

    PubMed  Google Scholar 

  38. Shabsigh R, Rajfer J, Aversa A, Traish AM, Yassin A, Kalinchenko SY, et al. The evolving role of testosterone in the treatment of erectile dysfunction. Int J Clin Pract. 2006;60(9):1087–92.

    CAS  PubMed  Google Scholar 

  39. Glina S, Glina FP. Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction. Ther Adv Urol. 2013;5(4):211–8.

    PubMed Central  PubMed  Google Scholar 

  40. Nicolosi A, Moreira Jr ED, Shirai M, Bin Mohd Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003;61(1):201–6.

    PubMed  Google Scholar 

  41. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.

    CAS  PubMed  Google Scholar 

  42. Chang S, Hypolite JA, Zderic SA, Wein AJ, Chacko S, Disanto ME. Increased corpus cavernosum smooth muscle tone associated with partial bladder outlet obstruction is mediated via Rho-kinase. Am J Physiol Regul, Integr Comp Physiol. 2005;289(4):R1124–30.

    CAS  Google Scholar 

  43. Kobayashi K, Kato R, Hisasue S, Yamashita S, Tanaka T, Masumori N, et al. Animal model for the study of the relationship between lower urinary tract symptoms/bladder outlet obstruction and erectile dysfunction. Int J Urol. 2011;18(10):710–5.

    PubMed  Google Scholar 

  44. Tinel H, Stelte-Ludwig B, Hutter J, Sandner P. Pre-clinical evidence for the use of phosphodiesterase-5 inhibitors for treating benign prostatic hyperplasia and lower urinary tract symptoms. BJU Int. 2006;98(6):1259–63.

    CAS  PubMed  Google Scholar 

  45. Gacci M, Corona G, Salvi M, Vignozzi L, McVary KT, Kaplan SA, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61(5):994–1003. Significant due to its overall review of the literature evaluating PDE5i use in combination with alpha blockers for BPH/LUTS supporting the conclusion that PDE5i therapy can significantly improve LUTS and erectile function in men with BPH.

    CAS  PubMed  Google Scholar 

  46. Ozturk MI, Koca O, Sertkaya Z, Keles MO, Kaya C, Karaman MI. Acute effects of sildenafil on uroflowmetric parameters in erectile dysfunction patients with and without lower urinary tract symptoms. J Androl. 2012;33(6):1165–8.

    CAS  PubMed  Google Scholar 

  47. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60(4):458–65.

    CAS  PubMed  Google Scholar 

  48. Laumann EO, Kang JH, Glasser DB, Rosen RC, Carson CC. Lower urinary tract symptoms are associated with depressive symptoms in white, black and Hispanic men in the United States. J Urol. 2008;180(1):233–40. An important study linking lower urinary tract symptoms, including erectile dysfunction, to depression, with differentiation by race.

    PubMed  Google Scholar 

  49. Perelman MA. Erectile dysfunction and depression: screening and treatment. Urol Clin N Am. 2011;38(2):125–39.

    Google Scholar 

  50. Boyarsky RE, Boyarsky S. Urological and behavioral approach to the treatment of secondary impotence. J Urol. 1978;119(2):229–30.

    CAS  PubMed  Google Scholar 

  51. Althof SE, Wieder M. Psychotherapy for erectile dysfunction: now more relevant than ever. Endocrine. 2004;23(2–3):131–4.

    CAS  PubMed  Google Scholar 

  52. Morse WI, Morse JM. Erectile impotence precipitated by organic factors and perpetuated by performance anxiety. Can Med Assoc J. 1982;127(7):599–601.

    CAS  PubMed Central  PubMed  Google Scholar 

  53. Rosen RC. Psychogenic erectile dysfunction. Classification and management. Urol Clin N Am. 2001;28(2):269–78.

    CAS  Google Scholar 

  54. Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard operating procedures for taking a sexual history. J Sex Med. 2013;10(1):26–35. An excellent primer on obtaining a sexual history.

    PubMed  Google Scholar 

  55. McCabe MP, Althof SE. A systematic review of the psychosocial outcomes associated with erectile dysfunction: does the impact of erectile dysfunction extend beyond a man’s inability to have sex? The Journal of Sexual Medicine 2013. Significant work demonstrating the impact of ED beyond the ability of a man to have sex and extending this impact to overall quality of life.

  56. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26.

    CAS  PubMed  Google Scholar 

  57. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.

    CAS  PubMed  Google Scholar 

  58. Rosen RC, Cappelleri JC, Gendrano 3rd N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14(4):226–44.

    CAS  PubMed  Google Scholar 

  59. Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17(4):307–19.

    CAS  PubMed  Google Scholar 

  60. Perelman MA. The impact of relationship variables on the etiology, diagnosis and treatment of erectile dysfunction. Adv Primary Care Med: Clin Updat. 2007;3:3–6.

    Google Scholar 

  61. Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metab Clin Exp. 2000;49(9):1239–42.

    CAS  PubMed  Google Scholar 

  62. Mohamed O, Freundlich RE, Dakik HK, Grober ED, Najari B, Lipshultz LI, et al. The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. Int J Impot Res. 2010;22(1):20–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  63. Pastuszak AW, Badhiwala N, Lipshultz LI, Khera M. Depression is correlated with the psychological and physical aspects of sexual dysfunction in men. Int J Impot Res. 2013;25(5):194–9.

    CAS  PubMed  Google Scholar 

  64. Hatzichristou D, Hatzimouratidis K, Bekas M, Apostolidis A, Tzortzis V, Yannakoyorgos K. Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol. 2002;168(2):615–20.

    PubMed  Google Scholar 

  65. Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol. 2004;171(6 Pt 1):2341–5.

    PubMed  Google Scholar 

  66. Ghanem HM, Salonia A, Martin-Morales A. SOP: physical examination and laboratory testing for men with erectile dysfunction. J Sex Med. 2013;10(1):108–10.

    PubMed  Google Scholar 

  67. Hatzichristou D, Rosen RC, Derogatis LR, Low WY, Meuleman EJ, Sadovsky R, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7(1 Pt 2):337–48.

    PubMed  Google Scholar 

  68. Kalinchenko SY, Tishova YA, Mskhalaya GJ, Gooren LJ, Giltay EJ, Saad F. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol. 2010;73(5):602–12.

    CAS  Google Scholar 

  69. Althof SE, Turner LA, Levine SB, Risen C, Kursh ED, Bodner D, et al. Intracavernosal injection in the treatment of impotence: a prospective study of sexual, psychological, and marital functioning. J Sex Marital Ther. 1987;13(3):155–67.

    CAS  PubMed  Google Scholar 

  70. Turner LA, Althof SE, Levine SB, Tobias TR, Kursh ED, Bodner D, et al. Treating erectile dysfunction with external vacuum devices: impact upon sexual, psychological and marital functioning. J Urol. 1990;144(1):79–82.

    CAS  PubMed  Google Scholar 

  71. Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On SEx and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013;10(9):2232–41.

    PubMed  Google Scholar 

  72. Dogan S, Dogan M. The frequency of sexual dysfunctions in male partners of women with vaginismus in a Turkish sample. Int J Impot Res. 2008;20(2):218–21.

    CAS  PubMed  Google Scholar 

  73. Roumeguere T, Wespes E, Carpentier Y, Hoffmann P, Schulman CC. Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk. Eur Urol. 2003;44(3):355–9.

    PubMed  Google Scholar 

  74. Weinberg AE, Eisenberg M, Patel CJ, Chertow GM, Leppert JT. Diabetes severity, metabolic syndrome, and the risk of erectile dysfunction. J Sex Med. 2013;10:3102–9.

    CAS  PubMed  Google Scholar 

  75. Buvat J. Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res. 2003;15(5):373–7.

    CAS  PubMed  Google Scholar 

  76. Donnelly P, White C. Testicular dysfunction in men with primary hypothyroidism; reversal of hypogonadotrophic hypogonadism with replacement thyroxine. Clin Endocrinol. 2000;52(2):197–201.

    CAS  Google Scholar 

  77. Kumar A, Chaturvedi PK, Mohanty BP. Hypoandrogenaemia is associated with subclinical hypothyroidism in men. Int J Androl. 2007;30(1):14–20.

    CAS  PubMed  Google Scholar 

  78. Donatucci CF, Lue TF. The combined intracavernous injection and stimulation test: diagnostic accuracy. J Urol. 1992;148(1):61–2.

    CAS  PubMed  Google Scholar 

  79. Broderick GA, Arger P. Duplex Doppler ultrasonography: noninvasive assessment of penile anatomy and function. Semin Roentgenol. 1993;28(1):43–56.

    CAS  PubMed  Google Scholar 

  80. Lewis RW, King BF. Dynamic color Doppler sonography in the evaluation of penile erectile disorders. Int J Impot Res. 1994;6:A30. Abstract.

    Google Scholar 

  81. Naroda T, Yamanaka M, Matsushita K, et al. Evaluation of resistive index of the cavernous artery with color Doppler ultrasonography for venogenic impotence. Int J Impot Res. 1994;6:D62.

    Google Scholar 

  82. Rudnick J, Bodecker R, Weidner W. Significance of the intracavernosal pharmacological injection test, pharmacocavernosography, artificial erection and cavernosometry in the diagnosis of venous leakage. Urol Int. 1991;46(4):338–43.

    CAS  PubMed  Google Scholar 

  83. Cilurzo P, Canale D, Turchi P, Giorgi PM, Menchini Fabris GF. The Rigiscan system in the diagnosis of male sexual impotence. Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell’Associazione per la ricerca in urologia = Urol, Nephrological, and Andrological Sci. 1992;64(2):81–5.

    Google Scholar 

  84. Perelman MA. The history of sexual medicine. In: Diamond L, Tolman D, editors. APA handbook of sexuality and psychology. Washington, D.C.: American Psychological Association; 2014.

    Google Scholar 

  85. Perelman MA. The sexual tipping point: a mind/body model for sexual medicine. J Sex Med. 2009;6(3):629–32.

    PubMed  Google Scholar 

  86. Melnik T, Soares BG, Nasselo AG. Psychosocial interventions for erectile dysfunction. Cochrane Database System Rev 2007;(3): CD004825.

  87. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc Mayo Clin. 2012;87(8):766–78. A critically important work evaluating the link between sexual function and cardiovascular risk in men and recommending cardiovascular evaluation in men with ED. This work supports the link between ED and general health, and the impact that both specialty and general physicians can have on the overall health of their patients.

    Google Scholar 

  88. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Int Med. 2011;17(20):1797–803. A very important work synthesizing the data on lifestyle modification and its impact on ED and demonstrating that lifestyle modification, even in the absence of medical therapy, can significantly improve ED and further linking ED to CAD and its associated risk factors.

    Google Scholar 

  89. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86–97.

    PubMed  Google Scholar 

  90. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol. 2005;99(3):1193–204.

    PubMed  Google Scholar 

  91. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008;117(23):3031–8.

    PubMed  Google Scholar 

  92. Jain P, Rademaker AW, McVary KT. Testosterone supplementation for erectile dysfunction: results of a meta-analysis. J Urol. 2000;164(2):371–5.

    CAS  PubMed  Google Scholar 

  93. Isidori AM, Buvat J, Corona G, Goldstein I, Jannini EA, Lenzi A, et al. A critical analysis of the role of testosterone in erectile function: from pathophysiology to treatment—a systematic review. Eur Urol. 2014;65(1):99–112. This work evaluated the impact of testosterone on erectile function using the existing literature, strongly supporting the biochemical and clinical roles of testosterone in hypogonadal men with ED and developing a pathophysiology-based treatment algorithm for hypogonadal men with ED.

    CAS  PubMed  Google Scholar 

  94. Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, et al. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. J Clin Endocrinol Metab. 2000;85(8):2839–53.

    CAS  PubMed  Google Scholar 

  95. Porst H, Burnett A, Brock G, Ghanem H, Giuliano F, Glina S, et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med. 2013;10(1):130–71.

    CAS  PubMed  Google Scholar 

  96. Tsertsvadze A, Fink HA, Yazdi F, MacDonald R, Bella AJ, Ansari MT, et al. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med. 2009;151(9):650–61.

    PubMed  Google Scholar 

  97. Buvat J, Lemaire A, Buvat-Herbaut M. Human chorionic gonadotropin treatment of nonorganic erectile failure and lack of sexual desire: a double-blind study. Urology. 1987;30(3):216–9.

    CAS  PubMed  Google Scholar 

  98. Guay AT, Bansal S, Heatley GJ. Effect of raising endogenous testosterone levels in impotent men with secondary hypogonadism: double blind placebo-controlled trial with clomiphene citrate. J Clin Endocrinol Metab. 1995;80(12):3546–52.

    CAS  PubMed  Google Scholar 

  99. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14.

    PubMed  Google Scholar 

  100. Dunn ME, Althof SE, Perelman MA. Phosphodiesterase type 5 inhibitors’ extended duration of response as a variable in the treatment of erectile dysfunction. Int J Impot Res. 2007;19(2):119–23.

    CAS  PubMed  Google Scholar 

  101. Wespes E, Amar E, Hatzichristou D, Hatzimouratidis K, Montorsi F, Pryor J, et al. EAU guidelines on erectile dysfunction: an update. Eur Urol. 2006;49(5):806–15.

    PubMed  Google Scholar 

  102. Goldstein I, McCullough AR, Jones LA, Hellstrom WJ, Bowden CH, Didonato K, et al. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012;9(4):1122–33.

    CAS  PubMed  Google Scholar 

  103. Glina S, Fonseca GN, Bertero EB, Damiao R, Rocha LC, Jardim CR, et al. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: a phase III clinical trial. J Sex Med. 2010;7(5):1928–36.

    CAS  PubMed  Google Scholar 

  104. Paick JS, Ahn TY, Choi HK, Chung WS, Kim JJ, Kim SC, et al. Efficacy and safety of mirodenafil, a new oral phosphodiesterase type 5 inhibitor, for treatment of erectile dysfunction. J Sex Med. 2008;5(11):2672–80.

    PubMed  Google Scholar 

  105. Kim BH, Lim HS, Chung JY, Kim JR, Lim KS, Sohn DR, et al. Safety, tolerability and pharmacokinetics of udenafil, a novel PDE-5 inhibitor, in healthy young Korean subjects. Br J Clin Pharmacol. 2008;65(6):848–54.

    CAS  PubMed Central  PubMed  Google Scholar 

  106. Wylie K. Erectile dysfunction. Adv Psychosom Med. 2008;29:33–49.

    PubMed  Google Scholar 

  107. Porst H, Adaikan G. Self-injection, transurethral and topical therapy in erectile dysfunction. In: Porst H, Buvat J, editors. Standard practice in sexual medicine. Malden: Blackwell Publishing; 2006. p. 94–108.

    Google Scholar 

  108. Mydlo JH, Volpe MA, Macchia RJ. Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy. Eur Urol. 2000;38(1):30–4.

    CAS  PubMed  Google Scholar 

  109. Porst H, Buvat J, Meuleman E, Michal V, Wagner G. Intracavernous alprostadil alfadex—an effective and well tolerated treatment for erectile dysfunction. Results a long-term European study. Int J Impot Res. 1998;10(4):225–31.

    CAS  PubMed  Google Scholar 

  110. Alexandre B, Lemaire A, Desvaux P, Amar E. Intracavernous injections of prostaglandin E1 for erectile dysfunction: patient satisfaction and quality of sex life on long-term treatment. J Sex Med. 2007;4(2):426–31.

    CAS  PubMed  Google Scholar 

  111. Rastrelli G, Corona G, Monami M, Melani C, Balzi D, Sforza A, et al. Poor response to alprostadil ICI test is associated with arteriogenic erectile dysfunction and higher risk of major adverse cardiovascular events. J Sex Med. 2011;8(12):3433–45.

    PubMed  Google Scholar 

  112. Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol. 1996;155(3):802–15.

    CAS  PubMed  Google Scholar 

  113. Thon WF, Hartmann U. [Effectiveness and safety of cavernous body auto-injection therapy with papaverine/phentolamine. Study group]. Der Urologe Ausg A. 1993;32(6):466–9.

    CAS  PubMed  Google Scholar 

  114. Kulaksizoglu H, Hakim LS, Nehra A, Goldstein I. Comparison of alprostadil sterile powder (Caverject®) with trimix. Nomogram and patient satisfaction. J Urol. 1997;157 Suppl 4:180.

    Google Scholar 

  115. Seyam R, Mohamed K, Akhras AA, Rashwan H. A prospective randomized study to optimize the dosage of trimix ingredients and compare its efficacy and safety with prostaglandin E1. Int J Impot Res. 2005;17(4):346–53.

    CAS  PubMed  Google Scholar 

  116. Sandhu D, Curless E, Dean J, Hackett G, Liu S, Savage D, et al. A double blind, placebo controlled study of intracavernosal vasoactive intestinal polypeptide and phenotolamine mesylate in a novel auto-injector for the treatment of non-psychogenic erectile dysfunction. Int J Impot Res. 1999;11(2):91–7.

    CAS  PubMed  Google Scholar 

  117. McMahon CG, Samali R, Johnson H. Treatment of intracorporeal injection nonresponse with sildenafil alone or in combination with triple agent intracorporeal injection therapy. J Urol. 1999;162(6):1992–7. Discussion 1997–1998.

    CAS  PubMed  Google Scholar 

  118. Kho HG, Sweep CG, Chen X, Rabsztyn PR, Meuleman EJ. The use of acupuncture in the treatment of erectile dysfunction. Int J Impot Res. 1999;11(1):41–6.

    CAS  PubMed  Google Scholar 

  119. Lee MS, Shin BC, Ernst E. Acupuncture for treating erectile dysfunction: a systematic review. BJU Int. 2009;104(3):366–70.

    PubMed  Google Scholar 

  120. Engelhardt PF, Daha LK, Zils T, Simak R, Konig K, Pfluger H. Acupuncture in the treatment of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled study. Int J Impot Res. 2003;15(5):343–6.

    CAS  PubMed  Google Scholar 

  121. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol. 1998;159(2):433–6.

    CAS  PubMed  Google Scholar 

  122. Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol. 2005;174(1):230–9.

    PubMed  Google Scholar 

  123. Ledda A, Belcaro G, Cesarone MR, Dugall M, Schonlau F. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU Int. 2010;106(7):1030–3.

    PubMed  Google Scholar 

  124. Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008;66(4):444–50.

    CAS  PubMed Central  PubMed  Google Scholar 

  125. Meuleman EJ. Experiences with a vacuum apparatus in the treatment of erection disorders. Nederlands Tijdschrift voor Geneeskunde. 1993;137(8):412–6.

    CAS  PubMed  Google Scholar 

  126. Brison D, Seftel A, Sadeghi-Nejad H. The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. J Sex Med. 2013;10(4):1124–35.

    PubMed  Google Scholar 

  127. Pahlajani G, Raina R, Jones S, Ali M, Zippe C. Vacuum erection devices revisited: its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. J Sex Med. 2012;9(4):1182–9.

    PubMed  Google Scholar 

  128. Bettocchi C, Palumbo F, Spilotros M, Lucarelli G, Palazzo S, Battaglia M, et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J S Med. 2010;7(1 Pt 1):304–9.

    Google Scholar 

  129. Wilson SK, Zumbe J, Henry GD, Salem EA, Delk JR, Cleves MA. Infection reduction using antibiotic-coated inflatable penile prosthesis. Urology. 2007;70(2):337–40.

    PubMed  Google Scholar 

  130. Sohn M, Hatzinger M, Goldstein I, Krishnamurti S. Standard operating procedures for vascular surgery in erectile dysfunction: revascularization and venous procedures. J Sex Med. 2013;10(1):172–9.

    PubMed  Google Scholar 

  131. Sohn M, Martin-Morales A. Surgical treatment of erectile dysfunction. In: Porst JB, Buvat J, editors. Standard practice in sexual medicine. Hoboken: Wiley; 2006. p. 126–48.

    Google Scholar 

  132. Brioni JD, Nakane M, Hsieh GC, Moreland RB, Kolasa T, Sullivan JP. Activators of soluble guanylate cyclase for the treatment of male erectile dysfunction. Int J Impot Res. 2002;14(1):8–14.

    CAS  PubMed  Google Scholar 

  133. Venkateswarlu K, Giraldi A, Zhao W, Wang HZ, Melman A, Spektor M, et al. Potassium channels and human corporeal smooth muscle cell tone: diabetes and relaxation of human corpus cavernosum smooth muscle by adenosine triphosphate sensitive potassium channel openers. J Urol. 2002;168(1):355–61.

    CAS  PubMed  Google Scholar 

  134. Martin WJ, McGowan E, Cashen DE, Gantert LT, Drisko JE, Hom GJ, et al. Activation of melanocortin MC(4) receptors increases erectile activity in rats ex copula. Eur J Pharmacol. 2002;454(1):71–9.

    CAS  PubMed  Google Scholar 

  135. Chitaley K, Wingard CJ, Clinton Webb R, Branam H, Stopper VS, Lewis RW, et al. Antagonism of Rho-kinase stimulates rat penile erection via a nitric oxide-independent pathway. Nat Med. 2001;7(1):119–22.

    CAS  PubMed  Google Scholar 

  136. Babaev A, Jhaveri RR. Angiography and endovascular revascularization of pudendal artery atherosclerotic disease in patients with medically refractory erectile dysfunction. J Invasive Card. 2012;24(5):236–40.

    Google Scholar 

  137. Melman A, Bar-Chama N, McCullough A, Davies K, Christ G. hMaxi-K gene transfer in males with erectile dysfunction: results of the first human trial. Hum Gene Ther. 2006;17(12):1165–76.

    CAS  PubMed  Google Scholar 

  138. Perelman MA. Psychosocial evaluation and combination treatment of men with erectile dysfunction. Urol Clin North Am. 2005;32(4):431–445, vi. An excellent article highlighting just how multifactorial sexual dysfunction is and the necessity for multimodal therapy.

    PubMed  Google Scholar 

  139. Perelman M. Integrated sex therapy: a psychosocial-cultural perspective integrating behavioral, cognitive, and medical approaches. In: Carson CC, Kirby RS, Goldstein I, Wyllie MG, editors. Textbook of erectile dysfunction. 2nd ed. London: Informa Healthcare; 2009. p. 298–305.

    Google Scholar 

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Alexander W. Pastuszak declares that he has no conflict of interest.

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    Alexander W. Pastuszak

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This article is part of the topical collection on Male Sexual Dysfunction and Disorders

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Pastuszak, A.W. Current Diagnosis and Management of Erectile Dysfunction. Curr Sex Health Rep 6, 164–176 (2014). https://doi.org/10.1007/s11930-014-0023-9

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