Clinical Review

Erectile dysfunction

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g129 (Published 27 January 2014) Cite this as: BMJ 2014;348:g129
  1. Asif Muneer, consultant urological surgeon and andrologist1,
  2. Jas Kalsi, consultant urological surgeon and andrologist2,
  3. Irwin Nazareth, professor of primary care and population science3,
  4. Manit Arya, senior lecturer and honorary consultant urological surgeon4
  1. 1University College Hospital, London, NW1 2PG, UK
  2. 2Wexham Park Hospital, Slough, Berkshire, UK
  3. 3Department of Primary Care and Population Health, University College London, UK
  4. 4University College Hospital, London, UK And Queen Mary University of London, UK
  1. Correspondence to: A Muneer mramuneer{at}gmail.com
  • Accepted 31 December 2013

Summary points

  • Erectile dysfunction has organic and psychogenic components

  • The incidence of erectile dysfunction increases with age and is a marker for endothelial dysfunction

  • Changes in lifestyle can help men with erectile dysfunction and reduce cardiovascular risk factors

  • First line treatment is with oral phosphodiesterase-5 inhibitors and second line treatment uses intraurethral or intracavernosal prostaglandins

  • Men who do not respond to drugs have the option of penile prosthesis surgery

Erectile dysfunction is defined as the inability to achieve and maintain a penile erection adequate for satisfactory sexual intercourse.1 Increasing public awareness and the universal availability of effective oral drugs has resulted in more men seeking treatment for the problem and an increase in the number of primary care consultations and referrals to secondary care. The World Health Organization states that “Sexual health is fundamental to the physical and emotional health and wellbeing of individuals, couples and families, and to the social and economic development of communities and countries.”2 Erectile dysfunction affects the quality of life for both patients and partners and is associated with relationship difficulties.

This review aims to provide an overview of the prevalence, investigation, and management of erectile dysfunction in primary care, together with indications for referral to secondary care.

Sources and selection criteria

We used the keywords erectile dysfunction and impotence combined with prevalence, risks, diagnosis, treatment, and surgery to search PubMed and Medline for relevant peer reviewed original articles, meta-analyses, and reviews. We also sourced national and international guidelines and consultations. Only papers written in English were considered.

How common is erectile dysfunction?

Data from the Massachusetts Male Aging Study (MMAS), a community based, random sample prospective observational survey of non-institutionalised men aged 40-70 years, found that 52% of men reported erectile dysfunction.3 It is a common cross cultural condition in developing and industrialised countries, but its true incidence is probably underestimated owing …

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