Erectile Dysfunction: Professional Evaluation and Evidence-Based Treatment

Why Medical Consultation Is Essential

ED is a symptom, not a diagnosis. It signals vascular, neurologic, hormonal, or psychogenic pathology. Self-medication with PDE5 inhibitors (sildenafil, tadalafil) without evaluation misses treatable causes and risks adverse events.

Comprehensive Assessment

• History: Onset, duration, rigidity, libido, morning erections, psychosocial context.
• Medication review: Antihypertensives, antidepressants, antipsychotics, 5-ARIs, opioids.
• Focused exam: Vascular (pulses, bruits), neurologic (bulbocavernosus reflex), genital, prostate.
• Labs: Fasting glucose, lipid panel, testosterone (total/free), LH, prolactin, TSH.
• Cardiovascular risk stratification: ED precedes coronary events by 3–5 years.

Treatment Tiers

1. Lifestyle: Weight loss, exercise, smoking cessation, Mediterranean diet, alcohol moderation.
2. Oral PDE5 inhibitors: First-line; require sexual stimulation; contraindicated with nitrates.
3. Vacuum erection device: Non-pharmacologic, effective for many.
4. Intracavernosal injections / intraurethral suppositories: Second-line.
5. Penile prosthesis: Surgical, high satisfaction, definitive.
6. Psychosexual therapy: For psychogenic/relationship components.
7. Testosterone replacement: Only if hypogonadal (symptoms + low levels).

Key Message

ED is common, treatable, and a window into cardiovascular health. Seek a urologist or sexual medicine specialist for personalized care.