Erectile Dysfunction (ED)
Definition &CausesSymptomsInvestigations & TreatmentsRisk Factors & PreventionOutcome
Definition and Causes:

Characterized by inability to achieve and maintain an erection of sufficient rigidity of penis for enough duration to perform sexual intercourse.



Sexual arousal is a very complex process involving nerves, blood vessels, muscles, hormones, brain signal and emotions. Any problem within the process may affect directly or indirectly and cause erectile dysfunction.


Common causes include:

  • Heart diseases
  • Clogged blood vessels (atherosclerosis)
  • High sugar or blood pressure
  • Obesity
  • Low male hormones (testosterone)
  • Certain medications
  • Tobacco use
  • Alcoholism
  • Enlarged prostate (male organ which forms sperms)
  • Treatment for prostate cancer
  • Injuries and surgeries which may affect lower abdomen/back (pelvic region) and spinal cord


Psychological causes of erectile dysfunction:

- Brain plays a major role in initial (arousal), event that

causes erection and it starts from sexual excitement.


- There are multiple factors which may affect the arousal

and includes:


  • Depression, anxiety or mental health condition
  • Stress
  • Relationship problems with the partner/ inhibitions and limitations of the surroundings
  • Poor communications


Back to Top

The patients presents with a complaint of:


  • Trouble getting an erection
  • Keeping an erection with sufficient rigidity to perform sexual intercourse
  • Reduced sexual desire to start with


Back to Top
Investigations and Treatment:

Diagnosis with erectile dysfunction (ED) is considered, if an individual cannot achieve or maintain an erection repeatedly for sexual performance for at least three months.



  • Detailed history is required to exclude other causes of dysfunction such as loss of libido or premature ejaculation. History should also include inquiry about a person's mental health any form of stress or anxiety or if the dysfunction is due to physical or psychological factors


Physical examination includes:

  • Assessment of BP, pulse, temp with local area examination of penis, testicles and nerves by stimulating surrounding sensitive areas. The detailed examination helps to identify between the physical/structural factors or neurological (nerve) involvement



  • Blood samples are collected and sent to check for common causes of ED i.e. blood sugar, cholesterol, and male hormone (testosterone) levels



  • To check the blood flow through the penis. A wand like device (transducer) held over the vessel supplying the penis, a video image is created to see if there is any problem in the blood flow


Overnight erection test:

  • Most men have erection during sleep without knowing it. A special tape is wrapped around your penis and if in the morning the tape is removed that means you had an erection unknowingly during your sleep, indicating the dysfunction is psychological and not physical



1) General principles:

  • Improve capacity to acquire and sustain an erection
  • Treatment varies according to the underlying condition.
  • Treat suspected underlying cause (if possible)
  • Avoid risk factors for ED
  • Use of ED specific medications


2) Non-pharmacologic:

  • Stress reduction, counseling, psychotherapy
  • Lifestyle modification including avoidance of risk factors, e.g. encourage reduction in use of recreational drugs including alcohol and tobacco, lose weight


3) Pharmacological:

When treating the underlying cause:

  • Use alternate medications for drugs that causes ED e.g. for high BP use calcium channel blockers (Norvasc) instead of beta blockers (Tenormin)


ED specific medications can be divided into:

  • Oral agents: Includes sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis); are all FDA approved agents


  • Note: The above agents are not recommended to be used with some drugs used for angina/ heart disease such as nitroglycerine.


  • Intrapenile self-Injections
    • Alprostadil (the prostaglandin PGE1): Injected into the base of the penis, maybe painful not recommended for daily use. Inject 10-20 mins before sex; erection may last up to an hour
  • Intrauretheral insertion:
    • Alprostadil: Gel inserted with an applicator into a small opening at the tip of the penis (urethera)


Mechanical devices:

  • Penile ring: Patient who can acquire but can't sustain an erection can use metal or plastic or leather ring which snaps around the base of the penis placed immediately after attaining the erection, to prevent blood draining out of the penis too quickly


  • Vacuum devices: Removes air from vacuum chamber over penis, creating a suction that draws blood into penile region. Once the blood rushes into the penis an elastic tourniquet at base holds blood so the erection can be sustained for sexual activity


Surgical implantation of penile prosthesis:

  • Reserved for patients who fail first and second line of treatment



Medications which are used to treat erectile dysfunction are as follows:


1-Image-Patient-ED-Medications- Treatment


Copyright © 2013 Innovate R&D


Back to Top
Risk Factors and Prevention:
  • Smoking
  • Over weight/ obese
  • Injuries
  • Enlarged prostate
  • Medications such as antidepressant, antihistamines etc.
  • Prostatic surgery and radiation therapy for cancers
  • Psychological conditions such as stress, anxiety or depression
  • Drug and alcohol misuse


Back to Top
  • With the variety of treatments available for erectile dysfunction, leads to satisfactory outcomes
  • The patient is unable to get the partner pregnant due to the dysfunction


Back to Top
Copyright © 2011-2019 Innovate R&D

educate Are you a Healthcare professional or patient?

Healthcare Professionals would include: Physicians (MD,OD), Physician assistants, Nurses, Pharmacists,Allied Health Workers (PT, OT, SLP, etc), Chiropractors, Paramedics, Optometrists, Dentists, Podiatrists etc, and students within these disciplines.

educate ** You are required to register **

eDucate is committed to optimizing the delivery of health information across the Healthcare continuum. To this end eDucate uses a wide array of learning tools, including Webinars, Quick Review Charts, Graphs, Brochures, Videos and Slide Presentations.

Professional Membership Benefits include free access to all archived and upcoming Webinars:

educate DISCLAIMER: This website is owned and operated by The Innovate Research and Development LP (Innovate R&D). All references herein to Innovate R&D shall be deemed to include any subsidiary, affiliate, associate or successor corporation of Innovate R&D. By entering and using this site, you agree to the "Terms of Use"for this website. If you do not agree to these terms and conditions then exit from this site immediately. Although Innovate R&D updates this website regularly with material believed to be accurate at the time of posting, Innovate R&D does not guarantee the accuracy, completeness, timeliness or currency of the material and consequently Innovate R&D expressly disclaims any liability for errors or omissions in the material contained in the website. The Innovate R&D website and all contents are provided as-is, and all representations and warranties, express or implied, relating to the website or the content are disclaimed, including any implied warranty of merchantability, fitness for a particular purpose or non-infringement, as well as any warranty of quality, functionality, accuracy, currency, completeness, reliability, operability, use performance or absence of viruses. In no way or event will Innovate R&D or any party that has been involved in the creation, production, promotion and marketing be liable to you or any other party for perceived direct or indirect damages. You assume all responsibility and risk of loss resulting from the use of our website.