Vascular diseases account for nearly 50% of all cases of ED in men older than 50 years. These diseases include atherosclerosis, peripheral vascular disease, myocardial infarction, and arterial hypertension. Vascular damage may result from radiation therapy to the pelvis and prostate in the treatment of prostate cancer. Both the blood vessels and the nerves to the penis may be affected. Radiation damage to the crura of the penis, which are highly susceptible to radiation damage, can induce ED.

For more on the etiology of ED, read here.

Pure psychogenic impotence is relatively uncommon. It is characterized objectively by the presence of good nocturnal and morning erections and negative findings on all other tests. However, a psychogenic component is often present in men with organic ED. A history of highly variable erections that can be totally absent one day but virtually normal the next suggests a psychogenic cause. Virtually 100% of men with severe depression have ED.

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A test used to evaluate penile function is the direct injection of prostaglandin E1 (PGE1; alprostadil [Caverject®]) into one of the corpora cavernosa. If the penile vasculature is normal or at least adequate, an erection should develop within several minutes. The patient and the clinician can judge the quality of the erection. If successful, this test also establishes penile injections as a possible therapy.

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In current practice, PDE5 inhibitors are the most commonly used treatment for ED. This drug class consists of sildenafil [Viagra®], vardenafil [Levitra®], tadalafil [Cialis®], and avanafil [Stendra®]. Sildenafil was the first in this series of PDE inhibitors.

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On occasion, men who have difficulty maintaining erections as a result of venous leaks may benefit from undergoing a surgical procedure designed to eliminate much of the venous outflow. Although initial enthusiasm for this and other surgical approaches was significant, this type of surgery has become rare because of a lack of long-term efficacy. AUA guidelines recommend against the use of such procedures.

For more about the treatment of ED, read here.

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Cite this article: Quiz: How Much Do You Know About Erectile Dysfunction? Medscape. Jun 18, 2015.