Internal Medicine

P1: OXT/OZN/JDO P2: PSB

0521779407-E-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

540 Erectile Dysfunction

■A thorough medical and psychosexual history

■A focused physical exam to rule out gynecomastia, testicular atrophy

or penile abnormalities such as Peyronie’s disease

tests

Laboratory

■CBC, urinalysis, fasting glucose, creatinine, lipid profile, and testos-

terone

■If testosterone low, check free testosterone, prolactin and luteinizing

hormone

■Injection and stimulation test to assess erectile function

■Doppler ultrasound to assess penile blood flow if necessary

Arteriography to examine for vascular occlusion

Cavernosometry/cavernosography to assess venous leakage

differential diagnosis

Distinguish from Erectile Dysfunction

■Congenital penile curvature or Peyronie’s disease – curvature of penis

with erection that may interfere with penetration

■Premature ejaculation – able to get erection but loses it after ejacu-

lation

■Painful erection – interrupting ability to have intercourse

■Micropenis – small phallus inhibiting successful intercourse

Classification of Erectile Dysfunction (ED)

■Organic ED (neurogenic, hormonal, drug-induced, vascular)

➣Neurogenic

Failure to initiate or conduct nerve impulse results in difficulty

in achieving and maintaining erections

Includes stroke, cerebral trauma, spinal cord injury, radical

pelvic surgery, neuropathy, pelvic trauma, Parkinson’s and

Alzheimer’s diseases

➣Hormonal

Hypogonadism: low testosterone due to testicular failure or

pituitary insufficiency

Hyperprolactinemia may be due to pituitary tumor or drugs

Androgen deficiency may affect nocturnal erections and libido

➣Drug-induced

Antipsychotics, antidepressants and centrally acting antihy-

pertensive