Clinical evaluation of erectile dysfunction in the era of PDE-5 inhibitors

Erectile dysfunction (ED) is a common disorder that has gained attention since the introduction of relatively safe treatment with phosphodiesterase-5 inhibitors. ED is a multifactorial disorder and a common presentation for several systemic illnesses, particularly vascular occlusive diseases. The clinical evaluation of ED should be thorough and systematic, with attention to the appropriate use of sexual symptom questionnaires and symptom scales, detailed medical and sexual history, physical examination, and basic screening laboratory tests. Patients should be referred for specialized evaluations when appropriate. The clinician must be familiar with the pathophysiologic mechanisms of ED, its associations with other systemic diseases, the indications for specialist referrals, and the role of specialized testing to diagnose and treat this disorder effectively.