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Erectile dysfunction (ED) is the most common sexual problem in men, The incidence increases with age and affects up to a third of men at some point in their life. It has a significant negative impact on intimate relationships, quality of life, and self-esteem. History and physical examination are sufficient to diagnose ED in most cases as there is no preferred first-line diagnostic test. The initial diagnostic work-up should usually be limited to a fasting serum glucose level and lipid panel, a thyroid-stimulating hormone test, and total morning testosterone levels, First-line therapy for ED consists of lifestyle change, modified drug therapy that may cause ED, and pharmacotherapy with phosphodiesterase type 5 inhibitors. Obesity, sedentary lifestyle, and smoking all greatly increase the risk of ED. Phosphodiesterase type 5 inhibitors are the most effective oral medications used to treat ED, including ED related to diabetes mellitus, spinal cord injuries, and antidepressants. Intraurethral and intracavernosal alprostadil, vacuum pump devices, and surgically implanted penile prostheses are alternative therapy options when phosphodiesterase type 5 inhibitors fail. Testosterone supplementation in hypogonadic men improves ED and libido, but requires interval monitoring of hemoglobin, serum transaminase, and prostate-specific antigen levels due to an increased risk of prostate adenocarcinoma. Cognitive behavioral therapy and therapy aimed at improving relationships can help improve ED. Screening for cardiovascular risk factors should be considered in men with ED because symptoms of ED appear on average three years earlier than symptoms of coronary artery disease. Men with ED are at increased risk for coronary, cerebrovascular, and peripheral vascular disease.
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