Erectile Dysfunction

Publication Date: September 1, 2018
Last Updated: March 14, 2022

Guideline Statements

Evaluation and Diagnosis:

Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle, )
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For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion, )
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Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle, )
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In men with ED, morning serum total testosterone levels should be measured. (Recommendation, C)
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For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion, )
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Treatment:

For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Recommendation, C)
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Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Recommendation, C)
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Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Standard, B)
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When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Standard, C)
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For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Standard, B)
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Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Recommendation, C)
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Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Recommendation, C)
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Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Recommendation, C)
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Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Recommendation, C)
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For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle, )
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Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens. (Recommendation, C)
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For men with ED who are considering ICI therapy, an in-office injection test should be performed. (Clinical Principle, )
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Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens. (Standard, C)
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Men with ED who have decided on penile implantation surgery should be counseled regarding post-operative expectations. (Clinical Principle, )
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Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection. (Clinical Principle, )
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For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Option, C)
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For men with ED, penile venous surgery is not recommended. (Recommendation, C)
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For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational. (Option, C)
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For men with ED, intracavernosal stem cell therapy should be considered investigational: (Option, C)
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For men with ED, platelet-rich plasma (PRP) therapy should be considered. (Expert Opinion, )
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Recommendation Grading

Overview

Title

Erectile Dysfunction

Authoring Organization

Publication Month/Year

September 1, 2018

Last Updated Month/Year

January 23, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction (ED).

Inclusion Criteria

Male, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D007172 - Erectile Dysfunction

Keywords

Reproductive Health, erectile dysfunction, ED