Causes of Erectile Dysfunction:

• Smoking
• Hypertension
• Arteriosclerosis
• Pelvic steal syndrome
• Diet and excerecise
• Venous insufficiency
• Hormonal cause- diabetes, thyroid, testosterone etc.
• Stress
• Snoring stops sex
• Obesity
• Surgical causes: radical prostectomy, turp, etc.
• Psychological causes : depression, anxiety or psychosis, fear, guilt, stress, performance anxiety or moral inhibition.
• Relationship causes.
• Aging : you can run, but you can’t hide.
• Peyronie’s disease
• External causes:
• Medications :aldomet, amytriptline, clonidine, capoten, cimetidine, digoxin, dilantin, hydrochorothiazide, inderal, ketoconazole, lopressor, minipress, moduretic, monopril, niacin, phenobarbital, prozac, sectral, tenormin, toprol, zestril, zoloft(sertraline) e
• Recreational drugs and alcohol.
• Bicycling
• Penile fracture: coitus interruptus with a “pop”.
• Priapism

Diagnosing ED

1. Medical History
2. Sexual History
3. Psychological History.
4. Physical Examination
5. Sex scores: Questionnaires: IIEF

Diagnostic Tests

1. Nocturnal Erections: Rigiscan
2. Doppler vascular assessment: Doppler ultrasound.
3. Erection induced by vibrotactile or audiovisual sexual stimulation or pharmacological induced erection – inject vasodilator-alprostadil –best study available at this time to confirm that penile blood flow is normal.
4. Venous insufficiency.
5. Penile brachial pressure index.
6. Penile plethysmography
7. Dynamic infusion cavernosometry and cavernosography.
8. arteriography
9. Cavernosal biopsy: for abnormalities of nitric oxide synthetase
10. Neurological tests: biothesiometry. Dorsal nerve conduction velocity etc.