Diagnostic Evaluation of Erectile Dysfunction AAFP

Diagnostic Evaluation of Erectile Dysfunction
THOMAS A. MILLER, CAPT, MC, USN
 Am Fam Physician. 2000;61(1):95-104

 A more recent article on erectile dysfunction is available
(https://www.aafp.org/afp/2016/1115/p820.html).
 See related patient information handout on erectile dysfunction

(https://www.aafp.org/afp/2000/0101/p109.html), written by the author of this
article.
Erectile dysfunction, the persistent inability to attain or maintain penile erection

sufficient for sexual intercourse, affects millions of men to various degrees. The
majority of cases have an organic etiology, most commonly vascular disease that
decreases blood flow into the penis. Regardless of the primary cause, erectile
dysfunction can have a negative impact on self-esteem, quality of life and
interpersonal relationships. The initial step in evaluation is a detailed medical and
social history, including a review of medication use. Discussion with the patient's
sexual partner may clarify exacerbating issues. The physical examination focuses on
the cardiovascular, neurologic and urogenital systems. Laboratory tests are useful to
screen for common etiologic factors and, when indicated, to identify hypogonadal
syndromes. Appropriate evaluation of erectile dysfunction leads to accurate advice,
management and referral of patients with erectile dysfunction.
Erectile dysfunction is defined as the persistent inability to attain or maintain penile

erection sufficient for sexual intercourse. The 1992 National Institutes of Health
Consensus Development Conference1 recommends use of the term “erectile
dysfunction” rather than “impotence,” because it more accurately defines the problem
and has fewer disparaging connotations. An estimated 10 to 20 million American men
have some degree of erectile dysfunction.1,2
Increased understanding of the male erectile process and the development of several
https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Page 1 of 20
agents to improve erectile function have generated great public interest among men
and their sexual partners. These advances are expanding the treatment options
available to primary care physicians in the management of erectile dysfunction. This
article describes the anatomy and physiology of erection, classification of erectile
dysfunction, and evaluation of patients with erectile dysfunction in the primary care
setting.
Anatomy
The penis consists of two parallel cylinders of erectile tissue, the corpora cavernosa,
and a smaller, single ventrally placed cylinder, the corpus spongiosum, which surrounds
the urethra and distally forms the glans penis (Figure 1). The corpora cavernosa are
composed of a mesh-work of interconnected cavernosal spaces lined by vascular
endothelium. They share an incomplete septum that allows them to function as a single
unit. 3 Blood flow is provided primarily by the cavernosal branches of the internal
pudendal artery. Each branch divides into numerous terminal branches that open
directly into the cavernous spaces. Venous drainage of the erectile bodies occurs via
postcavernous venules that coalesce to form large emissary veins that pierce the
tunica albuginea before draining into the deep dorsal vein.3
FIGURE 1.

Page 2 of 20
Anatomy of the penis.
Autonomic and somatic nerves innervate the penis. Parasympathetic nerve fibers
originate from sacral segments of the spinal cord, while sympathetic nerves originate
from lower thoracic and upper lumbar segments.3 Somatic sensory and motor fibers
enter and leave the sacral cord and innervate the penis and the perineum via the
pudendal nerve.
Physiology of Erection
In the flaccid penis, a balance exists between blood flow in and out of the erectile
bodies. Normal erectile function requires a complex set of dynamic neural and vascular
interactions. Penile erection can be elicited by at least two distinct mechanisms, central
psychogenic and reflexogenic,3 which interact during normal sexual activity.
Psychogenic erections are initiated centrally in response to auditory, visual, olfactory or
imaginary stimuli. Reflexogenic erections result from stimulation of sensory receptors
on the penis which, through spinal interactions, cause somatic and parasympathetic
efferent actions.3

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On arousal, parasympathetic activity triggers a series of events starting with the release
of nitric oxide and ending with increased levels of the intracellular mediator cyclic
guanosine monophosphate (cGMP). Increases in cGMP cause penile vascular and
trabecular smooth muscle relaxation.3,4 Blood flow into the corpora cavernosa
increases dramatically. The rapid filling of the cavernosal spaces compresses venules
resulting in decreased venous outflow, a process often referred to as the corporeal
veno-occlusive mechanism. The combination of increased inflow and decreased
outflow rapidly raises intracavernosal pressure resulting in progressive penile rigidity
and full erection (Figure 2).
FIGURE 2.
Mechanics of erection. (A) In the flaccid state, arterial vessels are constricted and venous vessels
are noncompressed. (B) On erection, smooth muscle relaxation in the trabeculae and arterial
vasculature results in increased blood flow, which rapidly fills and dilates the cavernosal spaces.
Venous outflow drops as the expanding cavernosal spaces compress the venous plexus and the
larger veins passing through the tunica albuginea.
Classification of Erectile Dysfunction

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Erectile dysfunction is divided into two etiologic categories: psychogenic and organic.
Most causes of erectile dysfunction were once considered to be psychogenic, but
current evidence suggests that up to 80 percent of cases have an organic cause.1
Organic causes are subdivided into vasculogenic, neurogenic and hormonal etiologies.
Vasculogenic etiologies represent the largest group, with arterial or inflow disorders
being the most common. Abnormalities of venous outflow (corporeal veno-occlusive
mechanism) are much less common. Regardless of the primary etiology, a psychologic
component frequently coexists.5
The severity of erectile dysfunction is often described as mild, moderate or complete,

although these terms have not been precisely defined. Erectile ability is just one aspect
of normal male sexual function. The male sexual response cycle consists of four major
phases: (1) desire, (2) arousal (erectile ability), (3) orgasm and (4) relaxation. Disorders
and dysfunction may occur in one or more of these phases,6 and the clinician
evaluating sexual function problems must clarify which phase is primarily responsible
for the patient's symptoms.
Conditions Associated with Erectile Dysfunction
Table 1 lists conditions associated with erectile dysfunction. Aging is an independent

risk factor, and although the incidence of erectile dysfunction increases steadily with
age, it is not an inevitable consequence of aging. In a recent study,2 one third of 70-
year-old men surveyed reported no erectile difficulty.
TABLE 1
Conditions Associated with Erectile Dysfunction
Aging
Chronic disease
Diabetes mellitus
Heart disease

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Hypertension
Lipid disorders
Renal failure
Liver disease
Vascular disease
Endocrine abnormalities
Hypogonadism
Hyperprolactinemia
Hypothyroidism/hyperthyroidism
Life style
Cigarette smoking
Chronic alcohol abuse
Neurogenic causes
Spinal cord injury
Multiple sclerosis
Herniated disc
Penile injury/disease
Peyronie's disease
Priapism
Anatomic abnormalities
Medications
Psychologic issues
Depression
Anxiety

Page 6 of 20
Social stressors
Trauma/injury
Pelvic trauma/surgery
Pelvic radiation
The most common medical conditions associated with erectile dysfunction are
conditions that impair arterial flow to the erectile tissues or disrupt the neuronal
circuitry. Patients with diabetes mellitus have high rates of erectile dysfunction as a
result of vascular disease and autonomic dysfunction.2
Many medications have been associated with various types of sexual dysfunction
(Table 2).7,8 As many as 25 percent of cases of erectile dysfunction are related to
medication side effects.1 In general, drugs that interfere with central neuroendocrine or
local neurovascular control of penile smooth muscle have the potential for causing
erectile dysfunction.9 The precise mechanisms remain controversial even with the most
frequently associated agents. Implication of many drugs is based on anecdotal
evidence or case reports.1,7 Medications used to treat hypertension, depression and
other psychiatric disorders are most commonly associated with erectile dysfunction.
TABLE 2
Drugs Most Commonly Associated with Sexual Dysfunction
Medication Type of sexual dysfunction*
Antihypertensive medications
Diuretics
Erectile dysfunction, decreased

Thiazides
libido

Spironolactone (Aldactone)
libido
Sympatholytics

Page 7 of 20
Central agents (methyldopa [Aldomet], Erectile dysfunction, decreased
clonidine [Catapres]) libido
Erectile dysfunction, ejaculatory

Peripheral agents (reserpine [Serpasil])
dysfunction
Erectile dysfunction, ejaculatory

Alpha blockers
dysfunction

Beta blockers (particularly nonselective agents)
libido
Psychiatric medications
Antipsychotic agents Multiple phases of sexual function
Antidepressants
Decreased libido, erectile

Tricyclic antidepressants
dysfunction
Monoamine oxidase inhibitors Multiple phases of sexual function
Ejaculatory dysfunction, erectile

Selective serotonin reuptake inhibitors
dysfunction
Anxiolytic agents
Benzodiazepines Decreased libido
Antiandrogenic

Digoxin (Lanoxin)
dysfunction

Histamine H2-receptor blockers
dysfunction
Others
Alcohol (long-term heavy use) Decreased libido, erectile

dysfunction

Page 8 of 20
Ketoconazole (Nizoral)
dysfunction
Niacin (Nicolar) Decreased libido

Phenobarbital
dysfunction

Phenytoin (Dilantin)
dysfunction
*—Most common type of sexual dysfunction is listed first.
Information from references 7 and 8.
Excessive and long-term use of a number of substances may also cause erectile
dysfunction. Cigarette smoking has been shown to be associated with erectile
dysfunction independent of smoking-related chronic illness.2 Chronic alcoholism,
through altered hormone metabolism and polyneuropathy, may also affect erectile
ability.7
Evaluation
The goals of the primary care patient evaluation, as outlined in Figure 3, are to assess
the likely cause of the erectile dysfunction and identify medical or psychologic
conditions that may be contributing to the dysfunction or that may influence treatment
options.
FIGURE 3.
Evaluation of Patient with Erectile Dysfunction

Page 9 of 20
Algorithm for the evaluation and management of patients with erectile dysfunction.
HISTORY
A thorough history is the most important factor in the evaluation of the patient with
erectile dysfunction. The initial step is to identify the patient's concern with his sexual
function. Several studies have indicated that patients and providers are reluctant to
address sexual topics. Physicians cite not knowing what questions to ask or how to ask
them, feeling uncomfortable with the topic, awkwardness with sex language and fears
of insulting the patient as reasons for their reluctance.10,11 However, evidence suggests
that the vast majority of patients believe sexual function is an appropriate topic to be
raised by their physician and are relieved when these topics are addressed.12

Page 10 of 20
Sexual function can often be incorporated in the discussion when reviewing the effects
of a patient's chronic medical problems or medication use. An effective technique in
this setting is to ask “inform-then-probe” type questions. First, provide information
about conditions that are commonly associated with sexual dysfunction, then follow
with a question about the individual's concerns. For example, you could say “Many men
(insert a condition that affects the particular patient, such as diabetes, hypertension,
medication, recent heart attack, etc.) experience sexual problems. Has this happened to
you?” This approach further educates the patient and reassures him that his symptoms
are common.
In other instances, the topic can be brought up in a nonthreatening way during the
standard review of systems by asking questions such as, “Are you currently sexually
active?” and “Are you or your partner experiencing sexual problems?”11 Depending on
the initial response, more focused questions may provide information on the patient's
social and sexual relationships. This information may help assess the patient's sexual
problems as well as identify high-risk behaviors and other concerns affecting the
patient's overall health.
Once a concern with the patient's sexual function is identified, the next step is to
differentiate erectile dysfunction from other sexual problems, such as loss of libido or
ejaculatory problems. The physician should use appropriate vocabulary, avoiding slang
or excessively technical terminology. Having the patient define the terms in his own
words will help the physician and patient communicate more effectively.13 The
International Index of Erectile Function (IIEF)14 is a valuable tool for defining the area of
sexual dysfunction (Figure 4). The IIEF is designed to be a self-administered measure of
erectile dysfunction, but it also assesses a patient's function in other phases of sexual
function. The IIEF also establishes a reliable baseline that can be used to monitor
changes related to treatment.
FIGURE 4.
International Index of Erectile Function

Page 11 of 20
The IIEF is a validated tool designed for detecting treatment-related responses in patients with
erectile dysfunction. In addition, the IIEF provides a broad measure of sexual function. As such, it
should be viewed as an adjunct to, rather than a detailed sexual history.
Reprinted with permission from Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A.
The international index of erectile dysfunction (IIEF): a multidimensional scale for assessment of
erectile dysfunction. Urol 1997;49:822–30.
Additional history, as outlined in Table 3, should clarify the duration, progression and

Page 12 of 20
severity of the erectile dysfunction, as well as any associated factors. Because erectile
dysfunction is frequently caused by medication, a review of the patient's drug therapy is
essential and should include prescription and over-the-counter medications. The
indications for use of a suspect medication and dosage changes can be considered.
TABLE 3
Sexual Function and Related History
Description of erectile dysfunction
Age at onset and duration
Association with specific event
Progression (rapid vs. gradual) of dysfunction
Quality of erections
Partial, unable to sustain
Frequency of dysfunction
Mild (occasional), moderate (often), complete absence
Setting of erectile dysfunction
Presence or absence of nocturnal erections
Presence or absence of dysfunction with different partners
Presence or absence of dysfunction with self pleasuring
Other sexual problems (loss of libido, ejaculation problems)
Presence of chronic disease
Use of prescription, over-the-counter, or recreational drugs
Cigarette smoking
Social issues
Relationships

Page 13 of 20
Life stressors
Expectations of patient and partner
Knowledge of sexual function
A social history also provides valuable information. Life stressors such as change in
social status, divorce, death of spouse, loss of job, or family problems may have an
effect on erectile function. Difficulty in erectile function affects the patient and his
partner, so it is important to assess whether the erectile problem is troubling one
partner more than the other, and if so, who and why. Finally, the physician should
determine the patient's and the partner's level of understanding of sexual anatomy and
function, as well as what expectations each has with regard to treatment outcome.
Men with erectile dysfunction and their partners often lack a full understanding of
sexual processes or have unrealistic expectations regarding sexual performance and
satisfaction.5
PHYSICAL EXAMINATION
The physical examination should assess the patient's overall health. Particular attention
should be given to the cardiovascular, neurologic and genitourinary systems, as these
systems are directly involved with erectile function. The cardiovascular examination
should include assessment of vital signs (especially blood pressure and pulse) and
signs of hypertensive or ischemic heart disease. Abdominal or femoral artery bruits and
asymmetric or absent lower extremity pulses are indicative of vascular disease. Skin
and hair pattern evidence of vascular insufficiency should be noted.
The patient's demeanor, dress, speech and overall appearance should be noted for
signs suggestive of anxiety or depressive disorders. Several reflexes can be tested to
evaluate sacral cord function. The superficial anal reflex, indicative of normal somatic
function of sacral cord levels S2–4, is assessed by touching the perianal skin and
noting contraction of the external anal sphincter muscles. The bul-bocavernosus reflex
also demonstrates normal sacral cord function. It is performed by placing a finger in
the rectum and noting contraction of the anal sphincter and bulbocavernosus muscle

Page 14 of 20
when the glans penis is squeezed. External anal sphincter tone can be assessed during
this maneuver as well.
The genital evaluation should assess for local abnormalities, such as hypospadias or
phimosis, and evidence of hypogonadism. The typical adult testis is 4.5 cm long with a
range of 3.5 to 5 cm. Beard, body hair and voice should be evaluated for signs of
hypogonadism. The penis should be palpated to determine the presence of local
abnormalities such as fibrous plaques of the fascial covering (Peyronie's disease). The
prostate gland should be assessed for size, consistency and symmetry.
ADDITIONAL STUDIES
If not previously done, some basic studies should be considered to identify

unrecognized systemic conditions that may predispose to erectile dysfunction. These
include a complete blood count, urinalysis, renal function, lipid profile, fasting blood
sugar, and thyroid function.
The value of routine endocrinologic testing remains controversial2,15–17 because the

incidence of endocrinopathy presenting as erectile dysfunction is low. Some evidence
suggests that men with low serum testosterone indicative of hypogonadism can be
identified by a combination of history and physical examination.16 However, most
authorities still recommend a basic endocrine screening because, in a small number of
patients, erectile dysfunction may be the initial manifestation of a serious disease such
as a prolactin-secreting tumor.17
The basic screen consists of serum testosterone and prolactin measurements. The
specific testosterone assay to be obtained is debated.15,17 Testosterone is
predominately protein-bound and is influenced by a variety of clinical conditions. It is
secreted in a diurnal manner with a peak in the morning. Normal testosterone levels
gradually decline with advancing age. An age-adjusted, first-morning, free testosterone
level is probably the most accurate measure.17 If the initial testosterone level is low,
follow-up studies should include luteinizing hormone and follicle-stimulating hormone
levels to differentiate testicular from hypothalamic-pituitary dysfunction. Elevated
prolactin levels warrant further evaluation, including hypothalamic-pituitary imaging.

Page 15 of 20
A variety of additional testing modalities to assess erectile function are available (e.g.,
nocturnal penile tumescence, intracavernous injection). These tests are not usually
performed in the family physician's office and are not necessary before the initiation of
therapy for most patients. Many of these tests are subject to significant variation in
interpretations and are most appropriate for use in refractory cases. These studies are
best done and interpreted in centers where they can be uniformly performed and
interpreted.
Putting It All Together
In most cases, a likely cause of the erectile dysfunction can be identified on the basis of
the information collected (Table 4). In all instances, medical conditions having an
impact on erectile function should be corrected or their progression controlled.
However, treatment of these conditions does not guarantee the return of erectile
function. Consideration should be given to discontinuation of any medication
suspected of contributing to the erectile problem or, if required, switching to an
alternative medication less likely to interfere with erectile function. Patients and their
partners should be educated about sexual issues and concerns. Discussing ways to
enhance romance and caressing may help couples have more satisfying sex lives.
TABLE 4
Likely Causes of Erectile Dysfunction Based on Clinical Presentation
Psychologic causes
Young age with abrupt onset
Onset associated with specific emotional event
Dysfunction in certain settings while normal function in others
Persistence of nocturnal erections
Previous history of erectile dysfunction with spontaneous improvement

Page 16 of 20
Excessive life stressors—work, relationships
Mental status findings suggestive of depression, psychosis or anxiety disorder
Organic causes
Vasculogenic—arterial
Persistent interest in sex
Older age with gradual onset
Impaired function in all settings
Presence of chronic disease (particularly diabetes, hypertension)
Use of prescription/over-the-counter medications associated with erectile

dysfunction
Smoking
Elevated blood pressure, evidence of peripheral vascular disease (bruits, decreased

pulses, skin and hair changes consistent with arterial insufficiency)
Vasculogenic—venous
Inability to maintain erection once established
Prior history of priapism
Local anomalies of the penis
Neurogenic
History of spinal cord/pelvic trauma or surgery
Presence of chronic disease (diabetes, alcoholism)
Presence of neurologic condition (multiple sclerosis, stroke)
Abnormal neurologic examination of genitals/perineum
Hormonal
Loss of interest in sexual activity
Small atrophic testis

Page 17 of 20
Low testosterone, elevated prolactin
Patients with low testosterone and normal prolactin can be considered for testosterone
replacement. Before the initiation of testosterone therapy, the patient should be
evaluated for the possibility of an occult prostate malignancy, which may be stimulated
by supplemental testosterone. Testosterone replacement may increase libido without
improving erectile function. Most patients with elevated prolactin levels can be
managed medically, but some will require neurosurgical treatment.
Given the effectiveness of several treatment modalities (e.g., oral or intraurethral

medication, vacuum constriction devices), it is reasonable to consider initiation of
treatment for the remaining patients regardless of the erectile dysfunction etiology.
Patients with suspected vasculogenic or neurogenic causes can be considered for a
trial of therapy in the primary care setting. Patients with a suspected psychogenic
etiology should be considered for sexual counseling or psychiatric referral as well.
Patients requesting a more comprehensive evaluation or those not responding to initial

therapy should be referred for further evaluation and treatment.
Author Information
THOMAS A. MILLER, CAPT, MC, USN, is an associate professor and vice-chair in the
Department of Family Medicine at the Uniformed Services University of the Health
Sciences, Bethesda, Maryland. A graduate of the University of Washington School of
Medicine, Seattle, he completed a family practice residency at the Naval Hospital, Camp
Pendleton, Calif.
The opinions expressed herein are those of the author and should not be construed as
official or as reflecting the views of the Uniformed Services University of the Health Sciences,
the Department of the Navy, or the Department of Defense.
Address correspondence to Thomas A. Miller, CAPT, MC, USN, Department of Family

Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd.,
Bethesda, MD 20814-4799. Reprints are not available from the author.
Reference(s)

Page 18 of 20
1. NIH Consensus Conference on Impotence. JAMA. 1993;270:83-90.
2. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its
medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J
Urol. 1994;151:54-61.
3. Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev. 1995;75:191-236.
4. Burnett AL. Role of nitric oxide in the physiology of erection. Biol Reprod. 1995;52:485-
9.
5. Rosen RC, Leiblum SR, Spector IP. Psychologically based treatment for male erectile
disorder: a cognitive-interpersonal model. J Sex Marital Ther. 1994;20:67-85.
6. First MB, ed. Sexual and gender identity disorders. In: Diagnostic and statistical
manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric
Association, 1994:493–515.
7. Brock GB, Lue TF. Drug-induced male sexual dysfunction. An update. Drug Saf.
1993;8:414-26.
8. Finger WW, Lund M, Slagle MA. Medications that may contribute to sexual disorders:
a guide to assessment and treatment in family practice. J Fam Pract. 1997;44(1):33-43.
9. Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction and
priapism. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, eds. Campbell's urology. 7th ed.
Philadelphia: Saunders, 1998:1157–79.
10. Lewis CE, Freeman HE. The sexual history-taking and counseling practices of
primary care physicians. West J Med. 1987;147:165-7.
11. Risen CB. A guide to taking a sexual history. Psychiatr Clin North Am. 1995;18:39-53.
12. Ende J, Rockwell S, Glasgow M. The sexual history in general medicine practice.
Arch Intern Med. 1984;144:558-61.
13. Franger AL. Taking a sexual history and managing sexual problems. J Reprod Med.
1988;33:639-43.

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14. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international
index of erectile dysfunction (IIEF): a multidimensional scale for assessment of erectile
dysfunction. Urol. 1997;49:822-30.
15. Burnett AL. Erectile dysfunction: a practical approach for primary care. Geriatrics.
1998;53(2):34-5.
16. Johnson AR, Jarow JP. Is routine endocrine testing of impotent men necessary. J
Urol. 1992;147:1542-4.
17. Lue TF, Broderick G. Evaluation and nonsurgical management of erectile

dysfunction and priapism. In: Walsh PC, Retik AB, Vaughn ED, Wein AJ, eds. Campbell's
Urology. 7th ed. Philadelphia: Saunders, 1998:1181–1214.
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Diagnostic Evaluation of Erectile Dysfunction

THOMAS A. MILLER, CAPT, MC, USN

 Am Fam Physician. 2000;61(1):95-104

 See related patient information handout on erectile dysfunction

Erectile dysfunction, the persistent inability to attain or maintain penile erection

Erectile dysfunction is defined as the persistent inability to attain or maintain penile

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Classification of Erectile Dysfunction

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

The severity of erectile dysfunction is often described as mild, moderate or complete,

Conditions Associated with Erectile Dysfunction

Table 1 lists conditions associated with erectile dysfunction. Aging is an independent

Conditions Associated with Erectile Dysfunction

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Chronic alcohol abuse

Spinal cord injury

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Drugs Most Commonly Associated with Sexual Dysfunction

Medication Type of sexual dysfunction*

Erectile dysfunction, decreased

Erectile dysfunction, decreased

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Erectile dysfunction, ejaculatory

Erectile dysfunction, ejaculatory

Erectile dysfunction, decreased

Antipsychotic agents Multiple phases of sexual function

Decreased libido, erectile

Monoamine oxidase inhibitors Multiple phases of sexual function

Ejaculatory dysfunction, erectile

Benzodiazepines Decreased libido

Decreased libido, erectile

Decreased libido, erectile

Alcohol (long-term heavy use) Decreased libido, erectile

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Niacin (Nicolar) Decreased libido

Decreased libido, erectile

Decreased libido, erectile

*—Most common type of sexual dysfunction is listed first.

Information from references 7 and 8.

Evaluation of Patient with Erectile Dysfunction

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

International Index of Erectile Function

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https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Sexual Function and Related History

Description of erectile dysfunction

Age at onset and duration

Association with specific event

Progression (rapid vs. gradual) of dysfunction

Partial, unable to sustain

Mild (occasional), moderate (often), complete absence

Setting of erectile dysfunction

Presence or absence of nocturnal erections

Presence or absence of dysfunction with different partners

Presence or absence of dysfunction with self pleasuring

Other sexual problems (loss of libido, ejaculation problems)

Presence of chronic disease

Use of prescription, over-the-counter, or recreational drugs

https://www.aafp.org/pubs/afp/issues/2000/0101/p95.html 22/02/24, 6.14 AM

Expectations of patient and partner