ReviewsNew insights into erectile dysfunction: a practical approach
Section snippets
Anatomy of the penis and mechanisms involved in achieving and maintaining an erection
Penile erection is a hemodynamic event in which central (cerebral and spinal) and local factors (smooth muscle and endothelium) are integrated in a complex manner involving a delicate balance between vasoconstrictor and vasodilator stimuli 9, 10. An understanding of the anatomy of the penis and the mechanisms regulating erections will aid physicians in determining the causes of ED in individuals.
Risk factors
Patients’ reluctance to seek treatment for ED may be due to mistaken beliefs about its causes and potential for treatment, a feeling of embarrassment, or the perception that, compared with other medical problems, ED is a low-priority concern. Unfortunately, some of the same problems arise with many primary care physicians 4, 21, 22. This is regrettable since primary care practitioners regularly evaluate and treat men and can, therefore, initiate discussion of sexual dysfunction. Evaluation and
Diagnosis
The importance of obtaining a detailed sexual history by sensitive but comprehensive questioning cannot be overestimated because, in addition to providing almost all the needed information, it assures patients that physicians are dealing seriously with the problem. Indeed, selecting the most appropriate therapy, considering the risk factors for the condition and the desires of the couple, can often be achieved without the need to undertake extensive testing. In this context, a variety of
Treatment
Although this review is not primarily directed at therapy, recent events require a description of currently available therapies. For a more detailed appraisal of some of the classical therapies, the reader is referred to the American Urological Association Erectile Dysfunction Clinical Guidelines 66, 67. These guidelines are, of course, written with urologists in mind, but nevertheless may provide some information of value to the practitioner.
In deciding what treatment options to discuss with
Conclusion
Erectile dysfunction is a common, readily treatable condition. It causes serious personal and social consequences that have finally begun to receive the attention they deserve. In particular, the misconception was widespread that ED was an inevitable consequence of aging and that treatment was difficult and unpalatable. If primary care physicians remain uncomfortable about opening discussions of sexual function, the condition will remain underdiagnosed and undertreated. Clearly, improving the
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