Erectile Dysfunction

Erectile dysfunction ( ED ) Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

Very common disorder Massachusetts Male Aging Study ( MMAS ) 1987-97 an important study revealed that 52 % men ( aged 40-70 yrs ) reported erectile dysfunction Prevalence and severity ↑es with age ED is a strong predictor of CVD in particular CAD

Risk factors Shares both unmodifiable and modifiable risk factors with CVD○ diabetes○ obesity○ dyslipidemia○ metabolic syndrome○ lack of exercise○ smoking , alcohol Age Poor physical and psychological health Lower urinary tract symptoms and BPH

Causes - vasculogenic Generalised CV disease Hypertension Hyperlipidemia Diabetes Smoking Major pelvic surgery or Radiotherapy ( pelvis or retroperitoneum ) Neurogenic -Degenerative disorders -eg multiple sclerosis , Parkinson's , multiple atrophy etc Spinal cord trauma or diseases Stroke CNS tumours Hormonal-Hypogonadism Hyperprolactinaemia Hyperthyroidism , Hypothyroidism Cushing's disease Hypopituitarism following traumatic brain injury Anatomical-Eg cavernous fibrosis , Peyronie's disease and penile fracture , micropenis , hypospadias , epispadias Psychological-Can be predisposing ( risk factors ) precipitating ( present ) or maintaining ( ongoing ) causes

History -Detailed medical and sexual history Comorbid conditions eg hypertension , peripheral vascular disease , diabetes , obesity , renal...