ASSESSMENT AND TREATMENT OF IMPOTENCE

Impotence is a common problem but is often neglected or inappropriatel y assessed and treated. Assessment should be focused toward causes of impotence that have specific treatments: psychogenic, drug induced, ho rmonal, and vascular. Specific treatments available are sexual counsel ing, medication adjustment, hormone therapy, and vascular surgery. Whe n impotence is neuropathic, of mixed etiology and/or unresponsive to d isease-specific treatments, therapy should be determined by patient pr eference. Options include vacuum erection devices, penile self-injecti on therapy, and penile prosthesis. There is less evidence supporting t he use of yohimbine, topical nitrates, or minoxidil.