From the Guidelines
The medical work-up for a 19-year-old with erectile dysfunction (ED) should begin with a comprehensive history and physical examination to identify underlying causes, as recommended by the American Urological Association (AUA) guideline 1. The physician should take a detailed sexual, psychological, and medical history, including medication use, substance use, and lifestyle factors.
- Key questions regarding ED include identifying the onset of symptoms, symptom severity, degree of bother, specification of whether the problem involves attaining and/or maintaining an erection, situational factors, the presence of nocturnal and/or morning erections, the presence of masturbatory erections, and prior use of erectogenic therapy.
- Laboratory tests should include morning serum total testosterone levels, as recommended by the AUA guideline 1, to determine if testosterone deficiency is present.
- Vital signs including pulse and resting blood pressure should be assessed, and a genital examination should include assessment of penile skin lesions and placement/configuration of the urethral meatus.
- Psychological assessment is crucial as anxiety, depression, and relationship issues are common causes of ED in young men, and referrals to specialists, such as psychotherapy or sexual/couples counseling, should be made if appropriate and available 1.
- Treatment depends on the underlying cause but may include lifestyle modifications, psychological counseling, or medications, and addressing psychological factors and treating any underlying medical conditions should be prioritized before considering medication in this age group.
- The AUA guideline recommends that men with ED should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment 1.
From the Research
Medical Work-up for Erectile Dysfunction
The medical work-up for a 19-year-old with erectile dysfunction (ED) should include:
- A full medical and personally and culturally sensitive sexual history 2
- A focused clinical examination 2
- Fasting glucose levels to check for diabetes mellitus 2
- A fasting lipid profile to check for dyslipidaemia 2
- In select cases, a total testosterone level and a prostate-specific antigen test may be necessary 2
Evaluation and Treatment
The evaluation of men with ED requires consideration of various factors, including:
- Physical illness, reaction to life stresses, or an unhappy couple relationship 3
- Lifestyle risk factors such as obesity and tobacco, alcohol, and illicit drug use 4
- Medical risk factors such as hypertension, diabetes, cardiovascular disease, renal failure, and medications 4 Treatment options for ED include:
- Lifestyle modification and reduction of comorbid vascular risk factors 2
- Pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5i) such as sildenafil, tadalafil, vardenafil, and avanafil 2, 5, 3, 6
- Psychosexual therapy alone or in combination with pharmacotherapy 2
- Patient-administered intracorporal injection therapy using vasodilator drugs such as alprostadil 2
- Surgical treatment with multicomponent inflatable penile implants 2