• To establish treatment of patient and partner.
• Use of diagnostic tests based on the patient’s presenting complaints and goals of therapy.
• To provide the patient and partner with a diagnosis and understanding of the likely etiology of ED.
• To offer treatment choices with comprehensive information on cost, likelihood of success and common side effects.
• To initiate therapy with the least invasive option that satisfies the patient’s and partner’s goals of treatment.
• To re-establish the couple’s ability to achieve and maintain sexual intimacy in as natural a manner as possible.
THE STEP-WISE APPROACH TO THE PATIENT
• Determine that ED exists, rather than premature ejaculation or sexual dysfunction from other causes (eg, Peyronie’s disease or a low desire state).
• Establish the timing of onset, nature of the problem and significance to the couple.
• Evaluate whether a potentially reversible cause of ED exists (eg, patient takes medication; is under stress; has depression or hormonal imbalance; uses tobacco, alcohol or cheap drugs; or has partner-specific issues).
• Categorize the etiology based on the patient’s history, physical examination and laboratory testing (optional). A commonly used schema for testing is:
— End organ (penile deformity)
Figure 1) Approaches to the management of erectile dysfunction. 1Optional testing. ICI Intracavernosal injections; Meds Medications; NTG Nitrates/nitroglycerine; Tx Treatment; VCD Vacuum constriction device