Erectile Dysfunction Disease

BASICS

DESCRIPTION

Dissatisfaction with size, rigidity, or duration of erection. Male sexual dysfunction encompasses an even larger group of complaints and disorders of arousal, desire, orgasm, sensation, and relationship. Transient periods of impotence occur in about half of adult males and are not considered dysfunctional.

System(s) affected: Reproductive, Nervous, Cardiovascular, Renal/Urologic
Genetics:
Rarely related to chromosomal disorders
Incidence/Prevalence in USA:
Erectile failure involves about 10% of men, but is underreported by patients
Predominant age:
- Patients with psychologic, gender, and primary organic problems often present themselves for help between adolescence and the third decade
- Patients with relationship problems, but concerned mainly about physical problems, tend to seek care in the sixth decade
- Most patients with physical problems are in the seventh and eighth decade, but rarely seek help
Predominant sex: Male only

SIGNS AND SYMPTOMS

Reduction of erectile size and rigidity
Inability to maintain erection
Inability to achieve erection
Reduced body hair
Thyromegaly
Gynecomastia
Testicular atrophy or absence
Deformed penis
Peripheral vascular disease
Neuropathy

CAUSES

Endocrine
Neurologic
Vascular
Medication
Psychological
Structural

RISK FACTORS

Prior pelvic surgery
Medication use
Risk factors for disorders listed in Causes

DIAGNOSIS

LABORATORY

CBC (Complete Blood Count)
Glucose
K+ (Potassium)
Na+ (Sodium)
Albumin
BUN/creatinine (Blood Urea Nitrogen/creatinine)
TSH (Thyroid-Stimulating Hormone)
Prolactin
Testosterone

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Most men over age 55 will have some test abnormality or risk factor, but it is not necessarily the cause of the patient's impotence

SPECIAL TESTS

24 hour urine zinc
Dorsal nerve somatosensory evoked potentials
Sacral evoked response
Penile-brachial blood pressures
Aortogram
Selective pudendal angiogram
Dynamic cavernosography
Nocturnal penile tumescence (NPT) testing
Penile blood pressure

IMAGING

Doppler, angiogram, cavernosogram

DIAGNOSTIC PROCEDURES

Response to papaverine or alprostadil injection

TREATMENT

APPROPRIATE HEALTH CARE

Since erectile dysfunction is multifactorial, evaluation by a generalist in an outpatient setting

GENERAL MEASURES

Early use of penile implants is now discouraged because of success with vacuum erectile devices, sensate focus therapy, injection therapy, and oral therapy.
Improve partner communication.
Reduce performance pressure.
Use sensate focus therapy.
Try vacuum erectile device or oral therapy.
Use of psychiatrists, psychologists, sex therapists, vascular surgeons, urologists, endocrinologists, neurologists, plastic surgeons, etc., often necessary for refractory cases.

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

Control diabetes if present

PATIENT EDUCATION

The New Male Sexuality by Bernie Zilbergeld, PhD., Bantam Books, 1992; and problem-specific handouts

FOLLOW UP

PREVENTION/AVOIDANCE

Since erectile dysfunction is multifactorial, referral to a sex therapist or couples therapist may help to speed recovery and prevent future problems

POSSIBLE COMPLICATIONS

Specific to therapy

EXPECTED COURSE AND PROGNOSIS

Given that the majority of patients have unspecified causes of their erectile disorders, vacuum erection device, injection or suppository therapy with alprostadil, oral sildenafil, and penile implant have improved the outlook greatly.
[Image of common erectile dysfunction treatments]
Expect 20% failure rate of vacuum erection device, high drop-out rate from injection therapy, and a 10-30% non-use rate for penile implants.
Spontaneous cure rate is about 15%.
Studies indicate a response rate of 40-60% for urethral alprostadil compared to 85-90% for the injection.
Sildenafil works in about 70% of persons at maximum dose.

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: Aging alone is not a cause of impotence
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.