Treatment Guideline Chart

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

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.

Erectile%20dysfunction Signs and Symptoms


  • Inability to attain and maintain an erection sufficient for satisfactory sexual performance
  • Prevalence increases with age as sexual activity decreases


  • Increasing evidence have shown that erectile dysfunction (ED) can be an early manifestation of coronary artery and 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

  • ED has common risk factors with cardiovascular (CV) diseases and may be the first presentation of an underlying medical condition (eg hypertension, diabetes mellitus)
  • Studies have shown that ED has been associated with lower urinary tract symptoms, benign prostatic hyperplasia (BPH), sexual dysfunction regardless of age, pelvic trauma, surgery, radiation, other comorbidities, and various lifestyle factors
Comorbidities and Risk Factors Associated with ED:
  • Diabetes mellitus
  • CV disease (eg hypertension, coronary artery disease, peripheral vascular disorders)
  • Hyperlipidemia and metabolic syndrome
  • Recreational habits (eg drug and/or alcohol abuse, heavy smoking)
  • Lack of regular physical exercise
  • Obesity
  • Major pelvic and prostate surgery (eg radical prostatectomy) or radiotherapy (pelvis or retroperitoneum)
  • Degenerative disorders (eg multiple sclerosis, Parkinson’s disease, multiple atrophy)
  • Spinal cord trauma or diseases
  • Stroke
  • Central nervous system tumors
  • Chronic renal failure, chronic liver failure
  • Polyneuropathy
  • Surgery of the urethra (eg urethral stricture, open urethroplasty)
  • Hypogonadism/testosterone deficiency
  • Hyperprolactinemia
  • Hyper- and hypothyroidism
Psychiatric and Psychogenic
  • Depression
  • Anxiety disorders
  • Relationship issues
  • Stress
  • Performance anxiety
  • Loss of attraction
  • Antiandrogens (eg Finasteride)
  • Antihypertensives (beta-blockers, Spironolactone, Methyldopa, thiazide diuretics)
  • Narcotics
  • Cimetidine
  • Antidepressants
  • Tranquillizers
  • Others (eg Clonidine, Guanethidine and Ketoconazole)
Penile Disorders
  • Hypospadias, epispadias, miropenis
  • Peyronie’s disease
  • Severe phimosis
  • Obstructive sleep apnea 
  • Sedentary lifestyle
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