Erectile dysfunction means an inability for an adult male to sustained an adequate erection to allow penetration.
| Organic causes |
Drug causes |
- Smoking - major
- Alcohol – major
- Diabetes mellitus (DM) – major
- Endocrine causes : hypogonadism, hyperthyroidism, prolactin excess, androgen deficiency, primary gonadal failure
- Neurological causes: spinal cord lesions, myasthenia gravis, autonomic neuropathy (e.g.: DM)
- Radiotherapy
- Renal failure
- Hepatic failure
- Prostatic hyperthrophy
- Surgical causes : post bladder-neck prostate surgery, post prostatectomy
- Penile abnormality : peyronie disease, post priapism
- Venous leak (valve incompetence)
- Vascular causes: peripheral vascular disease, aortoiliac occlusion, hypogastric-cavernous occlusion, pudendal artery occlusion
|
Antihypertensive – e.g.: beta blockers, diuretics, thiazide, methyldopa, clonidine
Digoxin
Major tranquilizers
Alcohol
Oestrogens
Levodopa
Opiates
Antidepressants – e.g.: monoamine oxidase (MOA) inhibitors, tricyclics
Barbiturates
Lithium
H2 blockers – e.g.: cimetidine
Steroids
Cancer chemotherapeutic
Metoclopramide
Phenytoin
Phenothiazine
Indomethacine
Antihistamine
Spirinolactone
Ketoconazole
|
If everything has been ruled out, the possible cause is psychological. Most of the time, the cause of erectile dysfunction is multifactorial.
Reference:
- Murray Longmore et al. Oxford handbook of Clinical Medicine. 7th edition
- David S. Smith et al. Field Guide to Bedside diagnosis. 2nd edition. 2007. Lippincott Williams and Wilkins.
Dysphagia means difficulty swallowing.
| Intrinsic lesion |
- Benign (peptic) stricture
- Malignant stricture
- Reflux stricture
- Foreign body
- Oesophageal ring or web
- Oesophageal cancer
- Pharyngeal pouch
- Zenker diverticulum
- Infectious oesophagitis
- Radiation injury
- Globus hystericus
|
| Neuromuscular disorder (transfer dysphagia) |
- Bulbar palsy
- Pseudobulbar palsy
- Dermatomyositis
- Muscular dystrophy
- Pharyngeal disorders
- Myasthenia gravis
|
| Motility disorder |
|
| Extrinsic pressure (external compression) |
- Goiter or thyromegaly
- Mediastinal glands
- Mediastinal mass
- Descending thoracic aortic aneurysm
- Paraesophageal diaphragmatic hernia
- Enlarged left atrium in mitral valve disease
|
Reference:
- Stephen Patchett et al. Pocket essentials of Clinical medicine.Kumar and Clark Family. 4th edition. Saunders Elsevier.
- David S. Smith et al. Field Guide to Bedside diagnosis. 2nd edition. 2007. Lippincott Williams and Wilkins.
