Abstract
Erectile dysfunction (ED) is a permanent inability to achieve and maintain erection sufficient for satisfying sexual intercourse. ED has a big influence on patients quality of life and it might be a first manifestation of serious cardiovascular disease.
Detailed medical and sexual history including validated questionnaires plays an important role in diagnostic evaluation. ED is often associated with modifiable risk factors, including lifestyle, administration of certain drugs, or diseases like diabetes, cardiovascular disorders or hypertension.
Elimination of risk factors and good compensation of associated diseases should be the first step of treatment. As a rule, ED can be treated successfully with current treatment options, but it cannot be cured.
The only exceptions are psychogenic ED, post-traumatic arteriogenic ED in young patients, and hormonal causes (e.g. hypogonadism and hyperprolactinaemia), which potentially can be cured with specific treatment. The treatment strategy depends on efficacy, safety, invasiveness and patient preference and it can be divided into three lines.
First line treatment includes administration of phosphodiesterase 5 inhibitors and vacuum erection devices. Intraurethral or intracavernous application of prostaglandin E1 and penile implants are suggested as second- and third-line treatments.