Differential Diagnosis for Difficulty Maintaining and Achieving Erection

Single Most Likely Diagnosis

• Erectile Dysfunction (ED) due to Vascular Disease: This is often the most common cause of erectile dysfunction, especially in older men. It is related to atherosclerosis, which affects blood flow to the penis, making it difficult to achieve or maintain an erection.

Other Likely Diagnoses

• Psychogenic Erectile Dysfunction: Psychological factors such as stress, anxiety, depression, or relationship issues can lead to difficulties in achieving or maintaining an erection.
• Diabetic Erectile Dysfunction: Diabetes can damage blood vessels and nerves that control erection, leading to erectile dysfunction.
• Hypogonadism (Low Testosterone): Low levels of testosterone can affect libido and the ability to achieve an erection.
• Medication-Induced Erectile Dysfunction: Certain medications, including antidepressants, antihistamines, and blood pressure medications, can cause erectile dysfunction as a side effect.

Do Not Miss Diagnoses

• Peyronie's Disease: A condition characterized by the development of scar tissue inside the penis, leading to curved, painful erections. It's crucial to diagnose and treat to prevent further complications.
• Priapism: A condition where an erection lasts for more than four hours and is not related to sexual stimulation or is painful. It's a medical emergency that requires immediate attention to prevent permanent damage.
• Testicular Cancer: Though rare, testicular cancer can lead to hormonal imbalances that might affect erectile function. Early detection is key for effective treatment.

Rare Diagnoses

• Pituitary Tumors: Tumors in the pituitary gland can affect hormone production, including testosterone, leading to erectile dysfunction.
• Neurological Disorders (e.g., Multiple Sclerosis, Parkinson's Disease): Certain neurological conditions can damage the nerves that control erection, leading to erectile dysfunction.
• Penile Artery Aneurysm or Atherosclerosis: Though less common, these conditions can significantly affect blood flow to the penis, causing erectile dysfunction.

Each of these diagnoses has a distinct set of causes and risk factors, and a thorough medical history, physical examination, and sometimes additional tests are necessary to determine the underlying cause of erectile dysfunction in an individual.