Differential diagnosis of erectile dysfunction

 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:

    1. Murray Longmore et al. Oxford handbook of Clinical Medicine. 7th edition
    2. David S. Smith et al. Field Guide to Bedside diagnosis. 2nd edition. 2007. Lippincott Williams and Wilkins.

    Infertility – male factors

     

    Problems with ejaculation and sustaining an erection

    • Diabetes mellitus
    • Peripheral vascular disease
    • Spinal injury

     

    Reduced sperm quality

    • Smoking
    • Sexual transmitted disease infection
    • Medical condition ( e.g.: on chemtotherapy)
    • Undescended testis
    • Past medical history – orchitis, mumps, varicocoele, post herniotomy

     

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