ERECTILE DYSFUNCTION

Erectile dysfunction is the inability to maintain an erect penis with sufficient rigidity for vaginal penetration and sexual satisfaction. I t is different from loss of libido, premature ejaculation, or absence of orgasm. It is an age-dependent disorder with an incidence of 1.9% a t 40 years and up to 25% at 65 years.(15) Moreover, certain diseases s uch as diabetes mellitus predispose the patient to erectile dysfunctio n with reported incidence as high as 50%.(24) Innovative laboratory an d clinical research in the hemodynamics, neurophysiology, and pharmaco logy of erection have greatly improved our understanding of the pathop hysiology of erectile dysfunction. To date, organic erectile dysfuncti on has been most frequently attributed to neurogenic and vasculogenic abnormalities. In most of the cases, however, the etiology of the dise ase is complex and involves more than one cause. Because intracavernou s injection therapy, in which the medication is injected directly into the corpus cavernosum, is successful in most patients regardless of t he cause of the impotence, the physician is often placed in the positi on of treating the symptom while overlooking the cause of erectile dys function. We believe that a basic workup including a detailed history, physical examination, and blood tests should be obtained in every pat ient. Additional tests can then be individualized according to the pat ient's general health, expectations, and goal. This article provides a n overview of our approach.