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  • Primer
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Erectile dysfunction

Nature Reviews Disease Primers volume 2, Article number: 16003 (2016) Cite this article

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Abstract

Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.

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Figure 1: Timeline of the understanding and treatment of erectile dysfunction.
Figure 2: Increasing prevalence of erectile dysfunction with age.
Figure 3: Penile smooth muscle contraction — the flaccid state.
Figure 4: Penile smooth muscle relaxation — the erect state.
Figure 5: Levels of androgen action in the control of sexual response.
Figure 6: Schematic representation of different types of hypogonadism.
Figure 7: Suggested diagnostic work-up for patients with erectile dysfunction.
Figure 8: Penile prostheses.
Figure 9: Potential future treatment options for erectile dysfunction.

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Author information

Authors and Affiliations

  1. Department of Urology, Tulane University School of Medicine, Box SL 42, 1430 Tulane Avenue, New Orleans, 70112–2699, Louisiana, USA

    Faysal A. Yafi & Wayne J. G. Hellstrom

  2. Sexual and Reproductive Medicine Program, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, New York, USA

    Lawrence Jenkins & John P. Mulhall

  3. Department of Development and Regeneration, Laboratory for Experimental Urology, Gene and Stem Cells Applications, University of Leuven, Leuven, Belgium

    Maarten Albersen

  4. Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy

    Giovanni Corona

  5. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy

    Andrea M. Isidori

  6. Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Shari Goldfarb & Christian J. Nelson

  7. Department of Experimental, Sexual Medicine and Andrology Unit, Clinical and Biomedical Sciences, University of Florence, Florence, Italy

    Mario Maggi

  8. Department of Medicine, Medicine, Albert Einstein College of Medicine, New York, Bronx, USA

    Sharon Parish

  9. Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy

    Andrea Salonia

  10. Department of Urology, Tan Tock Seng Hospital, Singapore

    Ronny Tan

Authors
  1. Faysal A. Yafi
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  2. Lawrence Jenkins
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  3. Maarten Albersen
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  4. Giovanni Corona
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  5. Andrea M. Isidori
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  6. Shari Goldfarb
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  7. Mario Maggi
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  8. Christian J. Nelson
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  9. Sharon Parish
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  10. Andrea Salonia
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  11. Ronny Tan
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  12. John P. Mulhall
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  13. Wayne J. G. Hellstrom
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Contributions

Introduction (R.T.); Epidemiology (A.S.); Mechanisms/pathophysiology (L.J., J.M., A.M.I.); Diagnosis, screening and prevention (G.C., M.M.); Management (L.J., J.M., F.A.Y., W.J.G.H.); Quality of life (C.N., S.G., S.P.); Outlook (M.A.); overview of Primer (L.J., J.M., F.A.Y., W.J.G.H.).

Corresponding authors

Correspondence to John P. Mulhall or Wayne J. G. Hellstrom.

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Competing interests

M.A. has received grants from Ferring, Bayer, ESSM and ISSM, and served as an advisor for Sandoz, Sobi and Sanofi. G.C. has received consultancy fees from Bayer, Besins, Otsuka, Eli-Lilly and Menarini. A.M.I. has served as an advisor for Otsuka, Shire, Besins, Novartis and Menarini. M.M. has served as an advisor and/or received speaker's fees from Bayer, Ely Lilly, Menarini, Prostrakan and Intercept. C.J.N. has served as an unpaid advisor for American Medical Systems. S.P. has served as an advisor for Pfizer, Sprout Pharmaceuticals, Emotional Brain and Strategic Science Technologies, and received speaker's fees from Pfizer. R.T. has served as an advisor for Lilly and Orient Europharma, and received speaker's fees from Lilly. J.P.M. has received grants from CIACT, NIH and SMSNA, and served as an advisor for Lilly, Pfizer and AMS. W.J.G.H. has served as an advisor for Abbvie, American Medical Systems, Coloplast and Pfizer. The other authors declare no competing interests.

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Yafi, F., Jenkins, L., Albersen, M. et al. Erectile dysfunction. Nat Rev Dis Primers 2, 16003 (2016). https://doi.org/10.1038/nrdp.2016.3

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