Erectile Dysfunction:
A guide to diagnosis and management

Correspondence:
Paul Arduca
Email: info@fmh.com.au

Abstract
BACKGROUND: Erectile dysfunction (ED) is a common age related problem best managed in general practice. The incidence of ED will thus increase as men live longer. It is only in the past decade that the pathophysiology of ED has been well understood.

OBJECTIVE: This article discusses the mechanisms of normal erectile function and dysfunction, and the assessment and management of ED.

DISCUSSION: The success of currently available and newly emerging oral agents has revolutionised the management of ED. However, the majority of men with ED remain undiagnosed and untreated and patients are often unable to distinguish between a problem of ED, desire or libido. It is particularly important for general practitioners to enquire about ED in middle aged and older men, diabetics and patients with vascular disease. Appropriate management goes beyond management of the actual condition, and involves addressing lifestyle and psychosocial issues.

Introduction
Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. The prevalence of the disorder is age related and varies depending upon the degree of dysfunction.(1) Erectile dysfunction affects men of all ages, from very early adulthood (when almost 10% of men are affected), to old age (76% of men aged 80 years and over are affected).(1) For practical clinical purposes, ED is due to:
• organic
• psychogenic, or
• a mixture of both organic and psychogenic factors (Table 1).

Table 1. Common causes of erectile dysfunction