Erectile dysfunction (ED) is a highly prevalent disorder affecting an estim
ated 152 million men worldwide and is associated with a variety of behavior
al risk factors, such as cigarette smoking and excessive alcohol consumptio
n, as well as numerous age - related medical conditions, notably type-2 dia
betes mellitus and cardiovascular disease. A rational step - wise approach
which includes comprehensive medical and sexual history, a focused physical
examination and essential laboratory tests such as fasting glucose, lipid
profile and testosterone assay is to be preferred. Current diagnostic work
- up does not recommend any of the specialized tests which were previously
considered mandatory-i. e. penile pharmacotesting, Duplex ultrasound and no
cturnal penile tumescence. Hormonal replacement therapy is appropriate only
in the hypogonadal male with ED. Prior to direct intervention, the physici
an should consider altering modifiable risk factors or causes, although fre
quently insufficient to reverse ED completely. When indicated, oral therapy
with new molecules (phosphodiesterase inhibitors or apomorphine) is the fi
rst - line treatment for the majority of patients because of potential bene
fits and lack of invasiveness.