2. Intro  Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse.  It has a significant impact on quality of life

4. Signs and symptoms  Erectile dysfunction symptoms may include persistent:  Trouble getting an erection  Trouble keeping an erection  Reduced sexual desire

5. causes  Neurogenic: spinal cord and brain injuries parkinson’s alzheimer’s multiple sclerosis stroke  Hormonal: pituitary gland tumors low levels of testosterone

6.  Arterial: peripheral vascular disease HTN decreased BF to the penis  carvasonal: peyronie’s disease  Surgery: radiation therapy prostate and bladder surgery cancer surgery surgery of the colon

7.  Aging  Alcohols  Drugs  Obesity cigarette smoking

8.  Physiological causes: anxiety depression relationship problems mental disorders

9. Risk factors  Medical conditions  Using tobacco  Overweight  Certain medical treatment  injuries  Medications  Psychological conditions  Drug and alcohol abuse

10. complications  An unsatisfactory sex life  Stress or anxiety  Embarrassment or low self-esteem  Marital or relationship problems  The inability to get your partner pregnant

12. Tests and diagnosis  Physical examination  Blood tests  Urine tests  Ultrasound  Overnight erection test (NPT)  Psychological exam  Penile angiogram  MRA

13. treatment  Sildenafil (Viagra)  Tadalafil (Cialis)  Vardenafil (Levitra, Staxyn)

14. Other treatments  Alprostadil penis suppository  Alprostadil self-injection  Testosterone replacement therapy  BEFAR  penile pumps  Penile implants  Hormone treatment  Blood vessel surgery  counselling

15. Alternative treatment  Korean red ginseng (Panax ginseng)  Dehydroepiandrosterone (DHEA)  L-arginine  Acupuncture  Herbal viagra

16.  Quit smoking  Loose weight  Get regular exercise  Get treatment for drug and alcohol problems  Work through relationship issues

17. Clinical case  a 56-year-old man who presents to his family physician for follow-up of hypertension control. During his history, he reports significant erectile dysfunction (ED) that has progressed over the past 8 months. This has been distressing to him and to his wife and has caused significant marital strife. He has been treated for hypertension for 4 to 5 years and is currently taking a combination of hydrochlorothiazide and atenolol with good blood pressure control..

18.  His past history includes obesity and a sedentary lifestyle. His blood pressure is moderately controlled (146/92 mm Hg). At 69 inches tall, he weighs 248 pounds He reports no morning erections, nocturnal erections, or spontaneous erections satisfactory for vaginal penetration. He has normal ejaculatory function pain or hematospermia. Physical examination is normal with normal genitalia, prostate examination, but a rotund abdomen that is nontender.

20. references  http://www.mayoclinic.org/diseases- conditions/erectile-dysfunction/basics/risk- factors/con-20034244 http://www.mayoclinic.org/diseases- conditions/erectile-dysfunction/basics/risk- factors/con-20034244  http://www.imedicure.com/hometopics/erectile- dysfunction/ http://www.imedicure.com/hometopics/erectile- dysfunction/  http://www.urologyhealth.org/urology/index.cfm?ar ticle=60 http://www.urologyhealth.org/urology/index.cfm?ar ticle=60