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Fortnightly review: Update on male erectile dysfunction

Male erectile dysfunction—defined as “the inability to achieve or maintain an erection sufficient for sexual intercourse”—is one of the most common sexual dysfunctions in men.1 Although erectile dysfunction can be primarily psychogenic in origin, most patients have an organic disorder, commonly with some psychogenic overlay.1 Some men assume that erectile failure is a natural part of the aging process and tolerate it; for others it is devastating. Withdrawal from sexual intimacy because of fear of failure can damage relationships and have a profound effect on overall wellbeing for the couple.2 Since erectile dysfunction often accompanies chronic illnesses, such as diabetes mellitus, heart disease, hypertension, and a variety of neurological diseases, physicians from many medical disciplines will see patients with this disorder.3

#### Summary points

Although around 10% of men aged 40 to 70 years have complete erectile dysfunction, only a few seek medical help

As erectile dysfunction is frequently associated with a number of systemic illnesses and surgical treatments, a wide range of doctors must be aware of the condition in their patients

Current effective treatments include psychosexual counselling, vacuum erection devices, intracavernosal and transurethral drug delivery, and penile prostheses

Promising oral treatments are currently being investigated

Both doctors and the public need to be better informed about erectile dysfunction and its treatment

The publications comprising this review were selected from a formal search of the full Medline database (using the terms erectile dysfunction, impotence, and penile erection). Articles from the authors' personal collections are also included.

The Massachusetts male aging study measured several health related variables in 1290 men aged 40 to 70 years.3 Erectile dysfunction was very common. Fifty two per cent of the men reported some degree of impotence—mild in 17.1%, moderate in 25.2%, and complete in 9.6%.3 Complete impotence was reported by 5% …