Erectile dysfunction (ED) refers to the persistent inability to achieve and maintain an erection adequate for sexual intercourse with a global prevalence in excess of 150 million and, left untreated, is widely recognized to decrease quality of life. Over one half of US males between the ages of 40 and 70 years report some degree of ED with the prevalence increasing with age and with the presence of cardiovascular risk factors such as smoking, diabetes mellitus, hyperlipidemia, and hypertension. ED may have numerous etiologies and its occurrence is often multifactorial with vasculogenic, hormonal, and emotional/psychological factors all contributing. As noted above, patients with ED frequently have cardiovascular risk factors or manifest cardiovascular disease, and indeed, many commonly prescribed pharmacotherapies for hypertension, heart disease, etc. can also promote ED. Prior pelvic trauma and central or peripheral neurologic disease may also be contributory. Despite the myriad factors listed however most ED ultimately is linked to a disorder of vascular structure or function and may relate to inadequate arterial flow, impaired cavernosal smooth muscle relaxation, or veno-occlusive dysfunction. It should be noted that given the coexistence of various contributory disease processes, evaluation and therapy for ED necessitate the coordinated, multidisciplinary efforts of urologists, vascular and sexual medicine specialists, and primary care physicians.
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