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ERECTILE DYSFUNCTION

Erectile dysfunction is the inability to attain and maintain an erection enough to have satisfactory sexual performance for ≥3 months.

It is when the patient complains of partial erection that could not attain vaginal penetration.

Complete loss of penile rigidity is uncommon.

Initial penile erections can penetrate but early detumescence occurs without ejaculation.

Definition

  • Inability to attain & maintain an erection enough to have satisfactory sexual performance for at least 3 months

Etiology

  • Increasing evidence have shown that erectile dysfunction can be an early manifestation of coronary artery & peripheral vascular disease

Signs and Symptoms

  • Complete loss of penile rigidity is uncommon
  • A patient may complain of partial erection that could not attain vaginal penetration
  • Initial penile erections can penetrate but early detumescence occurs without ejaculation
  • Nocturnal penile tumescence
  • Inability to maintain erection during private masturbation and/or erections related to erotic materials or other partners

Risk Factors

  • Erectile dysfunction has common risk factors as w/ cardiovascular diseases
  • Studies have shown that erectile dysfunction has been associated w/ lower urinary tract symptoms, benign prostatic hyperplasia, & sexual dysfunction regardless of age & other comorbidities & various lifestyle factors
Comorbidities & other risk factors that may contribute to erectile dysfunction:
Arteriogenic
  • Diabetes mellitus
  • Hypertension
  • Cardiovascular disease
  • Hyperlipidemia & the metabolic syndrome
  • Heavy smoking
  • Peripheral vascular disorders
  • Recreational drug abuse
Neurogenic
  • Trauma
  • Spinal cord injury
Endocrine
  • Diabetes mellitus
  • Hypogonadism/testosterone deficiency
  • Hyperprolactinemia
  • Hyper- & hypothyroidism
  • Obesity
Psychiatric & Psychogenic
  • Depression
  • Anxiety disorders
  • Relationship issues
  • Stress
  • Performance anxiety
  • Loss of attraction
Drugs
  • Antiandrogens (eg Finasteride) 
  • Antihypertensives (beta-blockers, Spironolactone, Methyldopa, thiazide diuretics)
  • Narcotics
  • Cimetidine
  • Antidepressants
  • Tranquillizers
  • Others
Penile Disorders
  • Peyronie’s disease
  • Severe phimosis
Others
  • Alcohol abuse
  • Obstructive sleep apnea 
  • Pelvic and prostatic radiation therapy
  • Pelvic and prostate surgery [eg transuretheral resection of the prostate (TURP), radical prostatectomy 
  • Sedentary lifestyle
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