Erectile Dysfunction Management

Diagnostic Evaluation

The British Medical Journal recommends that the diagnostic evaluation of erectile dysfunction should start with a detailed sexual and medical history, followed by a physical examination, including blood pressure and genital examination, to distinguish between psychogenic and organic origins 3, 4, 5.
The examination should also include an assessment of the patient's cardiovascular, neurological, and endocrine systems, as well as a review of their medication and lifestyle habits 3, 4, 5.
The American Urological Association suggests that routine laboratory tests, such as HbA1c and lipid profiles, should be performed to identify potential underlying causes of erectile dysfunction 6, 7, 8.
The International Index of Erectile Function (IIEF) and Sexual Encounter Profile (SEP) questionnaires can be used to characterize the frequency and severity of erectile dysfunction 6, 7.

The European Association of Urology recommends that the initial treatment of erectile dysfunction should be with phosphodiesterase type 5 inhibitors (IPDE5), such as sildenafil, vardenafil, and tadalafil, which have been shown to be effective in 60-65% of patients 1, 2, 6, 7.
The American College of Cardiology suggests that patients with erectile dysfunction should be stratified according to their cardiovascular risk factors before starting treatment with IPDE5 6, 7.
Lifestyle modifications, such as weight loss, exercise, and smoking cessation, can also improve erectile function and should be recommended to all patients 6, 7, 1.
The British Medical Journal recommends that patients with erectile dysfunction should be offered counseling and therapy, including cognitive-behavioral therapy and sex therapy, to address any underlying psychological issues 3, 5, 4.

The American Urological Association suggests that patients who do not respond to IPDE5 may be considered for second-line treatments, such as intracavernosal injections or vacuum devices 1, 2.
The European Association of Urology recommends that patients with refractory erectile dysfunction may be considered for third-line treatments, such as penile prostheses 1, 2.

The American Diabetes Association recommends that patients with diabetes should be managed with a multidisciplinary approach, including lifestyle modifications, medication, and counseling, to address the underlying causes of erectile dysfunction 6, 7.
The American Urological Association suggests that patients who have undergone prostatectomy may be considered for treatment with IPDE5, but with a lower dose and under close monitoring 1, 2.