Erectile dysfunction
ICD-10 N52.9
- ~0M
- US men with some degree of ED
- 0%
- prevalence at age 40
- 0-25%
- prevalence at age 65
- ~0%
- respond to first-line PDE5i
What is erectile dysfunction?
Erectile dysfunction (ED) is the persistent inability to attain or maintain an erection sufficient for satisfactory sexual performance. Prevalence rises with age, but ED affects ~30% of men age 40-70. Often the first visible sign of underlying cardiovascular disease — penile arteries are smaller and develop atherosclerosis earlier than coronaries.
What are the symptoms of erectile dysfunction?
- Difficulty getting an erection sufficient for satisfactory intercourse
- Difficulty maintaining an erection during intercourse
- Reduced morning or spontaneous erections (early marker of vascular cause)
- Reduced libido (suggests possible endocrine contribution — check testosterone)
- Premature or delayed ejaculation can coexist but is a separate diagnosis
Who is at risk for erectile dysfunction?
- Cardiovascular disease, hypertension, hyperlipidemia (ED is often the earliest warning)
- Diabetes (vascular + neuropathic mechanisms)
- Tobacco use (current or recent — vasoconstriction + endothelial damage)
- Obesity (low testosterone + vascular contribution)
- Medications: many antihypertensives, SSRIs, finasteride, beta-blockers, some opioids
- Pelvic surgery or radiation (prostatectomy is the most common iatrogenic cause)
- Depression and relationship stress (psychogenic component)
How is erectile dysfunction diagnosed?
Clinical history is sufficient for most cases. The International Index of Erectile Function (IIEF-5) questionnaire validates severity. Workup considers cardiovascular risk, testosterone, prolactin, and glucose. Sudden onset suggests psychogenic; gradual onset suggests organic (vascular, neurogenic, or hormonal) cause.
How is erectile dysfunction treated?
First-line: PDE5 inhibitors (sildenafil/Viagra, tadalafil/Cialis) — effective for 60-80% of men. Lifestyle: cardiovascular fitness, weight loss, smoking cessation. Second-line: alprostadil intracavernosal or intraurethral. Third-line: penile prosthesis. Treat underlying conditions (hypogonadism, depression, vascular disease) when present.
Medications used for erectile dysfunction
Authority reference: www.auanet.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Erectile Dysfunction: AUA Guideline · American Urological Association, 2018
- Erectile Dysfunction and Cardiovascular Disease · Journal of the American College of Cardiology, 2018 · PMID 30409258
- Massachusetts Male Aging Study — Prevalence of ED · Journal of Urology, 1994 · PMID 8254833
People also ask
What's the difference between Viagra and Cialis?
Viagra (sildenafil) works in 30-60 minutes and lasts about 4 hours — designed for on-demand use. Cialis (tadalafil) works in 30 minutes but lasts up to 36 hours, so the timing window is much wider; it can also be dosed daily for ongoing readiness. Same efficacy class, different time profile.
Are there free or low-cost ways to treat ED?
Generic sildenafil and tadalafil are widely available and cost a fraction of the brand-name versions. Telehealth platforms offer the generics at $1-5 per dose. Insurance coverage of ED treatment is plan-specific and often excludes lifestyle indications.
Can ED be a sign of heart disease?
Yes. ED frequently precedes cardiovascular events by 2-5 years because penile arteries are smaller than coronary arteries and show endothelial dysfunction earlier. New-onset ED in a man over 40 warrants a cardiovascular risk assessment.
Can I take PDE5 inhibitors if I'm on heart medication?
Nitrates (nitroglycerin, isosorbide) are an absolute contraindication — the combination can cause life-threatening hypotension. Alpha-blockers require careful timing and dose. Always disclose every cardiovascular medication you take to the prescriber.