Guidelines on the management of erectile dysfunction

British Society for Sexual Medicine

Epidemiology and risk factors

  • Erectile dysfunction (ED) has been defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance
  • The risk factors for ED (sedentary lifestyle, obesity, smoking, hypercholesterolaemia and the metabolic syndrome) are very similar to the risk factors for cardiovascular disease (CVD)
  • It is clear that ED may be associated with other causes of CVD such as hypertension, dyslipidaemia and endothelial dysfunction. ED may be the first presentation of serious medical conditions such as diabetes or hypertension


Initial assessment

  • Sexual history – a detailed description of the problem, including the duration of symptoms and original precipitants, should be obtained
  • Concurrent medical, psychiatric and surgical history should also be recorded, as should the current relationship status, history of previous sexual partners and relationships. Issues of sexual orientation and gender identity should also be noted. Finally, the patient should be asked about alcohol, smoking and illicit drug misuse
  • The use of validated questionnaires, particularly the International Index of Erectile Function (IIEF) or the validated shorter version of the SHIM (Sexual Health Inventory for Men) may be helpful

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