Pathophysiology of erectile dysfunction

Pathophysiology of erectile dysfunction

Vasculogenic
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Cardiovascular disease
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Hypertension
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Diabetes mellitus
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Hyperlipidaemia 
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Smoking 
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Major surgery or radiotherapy (pelvis or retroperitoneum)
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Neurogenic
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Central causes 
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Multiple sclerosis
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Multiple atrophy
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Parkinson’s disease
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Tumours
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Stroke
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Disk disease
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Spinal cord disorders
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Peripheral causes 
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Diabetes mellitus
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Alcoholism
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Uraemia 
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Polyneuropathy 
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Surgery (pelvis or retroperitoneum)
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Anatomical/structural
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Peyronie’s disease
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Penile fracture
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Congenital curvature of the penis
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Micropenis
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Hypospadias, epispadias
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Hormonal
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Hypogonadism
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Hyperprolactinemia
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Hyper- and hypothyroidism
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Cushing’s disease
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Drug-induced
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Antihypertensives (of all classes, most common by diuretics and beta-blockers)
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Antidepressants 
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Antipsychotics
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Antiandrogens
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Antihistamines
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Recreational drugs (heroin, cocaine, methadone)
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Psychogenic
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Generalized type (e.g. lack of arousability and disorders of sexual intimacy)
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Situational type (e.g. partner-related, performance-related issues or due to distress)

Sexual history
The sexual history may include information about previous and current sexual relationships, current emotional
status, onset and duration of the erectile problem, as well as possible previous consultations and treatments.
Detailed descriptions of the quality of both erotic and morning erections, in terms of rigidity and duration, as
well as arousal, ejaculation and orgasmic problems, should be discussed. The use of validated questionnaires,
such as the International Index for Erectile Function (IIEF), may be helpful in order to assess all sexual function
domains (erectile function, orgasmic function, sexual desire, ejaculation, intercourse and overall satisfaction),
but also the impact of a specific treatment modality .

Physical examination
A focused physical examination must be performed on every patient, with particular emphasis on the
genitourinary, endocrine, vascular and neurological systems (16). The physical examination may reveal
unsuspected findings, such as Peyronie’s disease, prostatic enlargement or cancer, as well as the signs and
symptoms indicative of hypogonadism (small testes, alterations in secondary sexual characteristics, diminished
sexual desire, and changes in mood) (17). A rectal examination should be performed in every patient older than
50 years. Blood pressure and heart rate should be measured if they have not been assessed in the previous 
3-6 months. Particular attention must be given to patients with cardiovascular disease.
Laboratory testing
Laboratory testing must be tailored to the patient complaints and risk factors. All patients must undergo a
fasting glucose and lipid profile if not assessed in the previous 12 months. Hormonal tests must include a