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The understanding of the various etiologies and
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Etiology and Risk Factors of Erectile Dysfunction
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Fig 51 Commonly reported physical
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Diabetes Neurologic Vascular risk Drugmellitus (including surgical) induced factors (excluding diabetes)
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Endocrinal
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etiologies for ED
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Fig 52 The most prevalent co-morbid
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Depression / Anxiety Hypertension Hypercholesterolemia Diabetes mellitus Cardiovascular disease / Angina
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conditions associated with ED
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risk factors for ED is imperative to guide the management plan Expertise can assist us in tailoring the history-taking and physical examination to identify reversible risk and lifestyle factors, as well as to select the appropriate laboratory tests and investigations, as needed Unnecessary, expensive, and potentially invasive investigations are dispensable in the majority of ED patients, so costs can be saved Such knowledge would also allow us to educate our patients and their partners and to assist them in modifying reversible causes of erectile dysfunction, thus enhancing the treatment outcome
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References
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1 Masters WH, Johnson VE, eds Human Sexual Inadequacy Boston: Little Brown, 1970 2 Kaplan HS, ed The New Sex Therapy New York: Brunner/Mazel, 1974 3 Melman A, Tiefer L, Pederson R Evaluation of the rst 406 patients in urology department-based service center for male sexual dysfunction Urology 1988; 32:6 10 4 Kamp S, Ott R, Knoll T, et al REM-sleep deprivation leads to a decrease of nocturnal penile tumescence (NPT) in young healthy males: The signi cance of NPT-
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measurements (61113) XVII World Congress of Sexology, July 10 15, Montreal, Canada, 2005 Kratzik CW, Schatzl G, Lunglmayr G, et al The impact of age, body mass index and testosterone on erectile dysfunction J Urol 2005;174:240 243 Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB Modi able risk factors and erectile dysfunction: can lifestyle changes modify risk Urology 2000;56(2):302 306 Esposito K, Giugliano F, Di Palo C, et al Effect of lifestyle changes on erectile dysfunction in obese men JAMA 2004;291:2978 2984 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, Mckinaly JB Impotence and its medical and psychosocial correlates: results of the massachusetts male aging study J Urol 1994;151:54 61 Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, Rodriguez-Vela L, Jimenez-Cruz JF, Burgos-Rodriguez R Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study J Urol 2001;166:569 574 Nazareth I, Boynton P Problems with sexual function in people attending London general practitioners: cross sectional study BMJ 2003;327:423 428 Michal V Arterial disease as a cause of impotence Clin Endocrinol Metab 1982;11:725 748 Sullivan ME, Keoghane SR, Miller MA Vascular risk factors and erectile dysfunction BJU Int 2002; 87(9):838 45 Shamloul R, Ghanem H, Salem A, Elnashaar A, Elnaggar W, Darwish H, Mousa A Correlation between penile duplex ndings and stress electrocardiography in men with erectile dysfunction Int J Impot Res 2004;16:235 237 Billups KL, Bank AJ, Padma-Nathan H, et al Erectile dysfunction is a marker for cardiovascular disease: results of the minority health institute expert advisory panel J Sex Med 2005;2:40 52 Lochman A, Gallmetzer J Erectile dysfunction of arterial origin as possible manifestation of atherosclerosis Minerva Cardioangiol 1996;44(5):243 246 Mittleman MA, Siscovick DS Physical exertion as a trigger of myocardial infarction and sudden cardiac death Cardiol Clin 1996;14:263 270 O Kane PD, Jackson G Erectile dysfunction, is there silent obstructive coronary artery disease Int J Clin Prac 2001;55(3):219 220 Muller SC, El Damanhoury H, Ruth J, Lue TF Hypertension and Impotence Eur Urol 1991;19: 29 34 19 Oaks WW, Moyer JH Sex and Hypertension Med Aspects Hum Sexual 1972;6:128 137 20 Burchardt M, Burchardt T, Baer L, et al Hypertension is associated with severe erectile dysfunction J Urol 2000;164:1188 1191 21 Ahn TY, Saenz de Tejada I Effects of hypercholesterolemia and nitric oxide synthesis inhibition on rabbit corpus cavernosum tissue Int J Impotence Res 1992;4:Suppl2,A5 22 Chen JH, Lee KR Lipid composition of human corpus cavernosum analyzed by high resolution 1H and 13C-nuclear magnetic resonance spectroscopy J Urol 1997;157:No4,Suppl360 23 Seftel AD, Azadzoi K, Krane RJ, et al Hypercholesterolemia impairs neurogenic and endotheliumdependent responses in rabbit cavernosal arteries J Urol 1993;149:No4,Suppl247 24 Wei M, Macera C, Davis D, Hornung Ca, Nankin H, Blair S Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction Am J Epidemiol 1994;140:930 937 25 Juenemann KP, Muth S, Rohr G, et al Does lipid metabolism in uence the pathogenesis of vascular impotence Part 1 Int J Impotence Res 1990;2:Suppl2,33 26 Manning M, Schmidt P, Juenemann KP, et al The role of blood lipids in erectile failure Int J Impotence Res 1996;8:No3, D179 27 Kim JH, Klyachkin MC, Svendsen E, et al Experimental hypercholesterolemia in rabbits induces cavernosal atherosclerosis J Urol 1993;149:No4,Suppl246 28 Saltzman EA, Guay AT, Jacobson J Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation J Urol 2004;172:255 258 29 Rosen MP, Green eld AJ, Walker TG, Grant P, Dubrow J, Bettman MA, Fried LE, Goldstein I Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric cavernous arterial bed of men with arteriogenic impotence J Urol 1991;145: 759 763 30 Juenemann KP, Lue TF, Luo JA, Benowitz NL, Abozeid M, Tanagho EA The effect of cigarette smoking on penile erection J Urol 1987;138(2):438 441 31 Glina S, Reichet AC, Leao PP, Dos-Reis JM Impact of cigarette smoking on papaverine-induced erection J Urol 1988;140(3):523 524 32 Hatzichristou DG, Seftel A, Saenz De Tejada I Sexual dysfunction in diabetes and other autonomic neuropathies In: Singer C, Weiner WJ, eds Sexual Dysfunction: A Neuro-Medical Approach Armonk: Futura Publishing Company, 1994, pp 167 198
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