Erectile dysfunction

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Contents

Erectile Dysfunction

History-

Age-

Onset & Progression-

AM Erections-

Situations & Frequency-

Chronic Disease-

Medications-

Smoking-

Stressors-

PE - BP / Pulse
GU- Abdominal / Femoral Vascular Auscultation

EAS Contraction (S2-S4), Hypospadias, Phimosis, Hypogonadism, Prostate Size


DDx: Aging / Psychogenic/ Neurogenic /Vasculogenic / Iatrogenic / Hormonal etiologies

Suggestive of Hormonal: decreased libido, premature ejaculation, fatigue) and physical findings (e.g., testicular or muscular atrophy

Work-Up

CBC, BMP, UA, TSH, FLP, 1st Total T4, Prolactin.

If Total T4 <300 x2(<230 treated with Testosterone tend to show benefit.), Diagnose Hypogonadism & check LH & FSH (If high Primary Hypogonadism). Referral to Endrocrine may be appropriate.

Treatment
Treat Medical Conditions
Modify Medication Therapy

PDF5-Inhibitors for diabetes mellitus and spinal cord injury, and of sexual dysfunction associated with antidepressants. A 9, 12, 17, 19–21 Additional therapy for erectile dysfunction may consist of psychosocial therapy and testosterone supplementation in men with hypogonadism. B 8, 13, 36 Testosterone supplementation in men with hypogonadism improves erectile dysfunction and libido.


References

Diagnostic Evaluation of ED - AAFP 2000

Management of ED - AAFP 2010

Practical Guide to Male HypoGonadism - 2010

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