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Erectile dysfunction (ED) is a common problem in men as they age. Generally described as the inability to acquire or sustain a penile erection that is firm enough for satisfactory sexual performance. Over 20% of men may suffer from moderate to severe ED by the age of 40 years.1 ED can be considered organic, psychogenic, or mixed. Organic ED is due to physical defects either in the relevant neurologic or vascular anatomy and can result from various etiologies including vasculogenic, neurogenic, or hormonal. Psychogenic ED is resultant from various factors and psychologic conflicts inhibit neuropathways responsible for erections including anxiety about the sexual experience, guilt, anger, lack of confidence, depression, or psychosis, among others.2 A leading cause of organic ED is from diabetes mellitus with hyperglycemia causing damage to the cavernosal nerve and small vessel and ultimately neuropathy and arteriogenic insufficiency.3 As a marker for small vessel arteriosclerosis, ED is a marker of vascular disease and will precede and predict the development of arterial blood vessel disease in other vessels, classically coronary artery disease. This may occur months to years prior to patients becoming symptomatic from the vascular pathology in other organs. For this reason, the American Urologic Association (AUA) recommends an evaluation for dyslipidemia, diabetes, and possible consultation to a cardiologist in patients with ED that is gradual in onset. A list of risk factors mentioned in the AUA Guidelines for ED is listed in Table 52-1.

TABLE 52-1The Independent Risk Factors for Erectile Dysfunction


There are multiple etiologies of ED in men which include from most to least common: vascular, diabetes, medication induced, surgical or radiation changes, neurological, endocrinopathy, and others.4,5 ED can also be categorized as a psychogenic, organic (without a psychological component), or mixed, a list of causes detailed in Table 52-2.

TABLE 52-2Causes of Erectile Dysfunction

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