Erectile Dysfunction Guidelines

Updated: Aug 09, 2018
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Guidelines

Guidelines Summary

American Urological Association (AUA) guidelines on erectile dysfunction (ED) contain the following recommendations on evaluation and diagnosis [1] :

  • Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle)
  • For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion)
  • Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle)
  • In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
  • For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) 

AUA recommendations for treatment of ED are as follows:

  • Referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C)
  • Men with ED who have comorbidities known to negatively affect erectile function should be counseled that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C)
  • Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
  • When men are prescribed an oral PDE5i for the treatment of ED, instructions should be provided to maximize benefit/efficacy. (Strong Recommendation; Evidence Level: Grade C)
  • For men who are prescribed PDE5i, the dose should be titrated to provide optimal efficacy. (Strong Recommendation; Evidence Level: Grade B)
  • Men who desire preservation of erectile function after treatment for prostate cancer by radical prostatectomy (RP) or radiotherapy (RT) should be informed that early use of PDE5i post-treatment may not improve spontaneous, unassisted erectile function. (Moderate Recommendation; Evidence Level: Grade C)
  • Men with ED and testosterone deficiency (TD) who are considering ED treatment with a PDE5i should be informed that PDE5i may be more effective if combined with testosterone therapy. (Moderate Recommendation; Evidence Level: Grade C)
  • Men with ED should be informed regarding the treatment option of a vacuum erection device (VED), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C
  • Men with ED should be informed regarding the treatment option of intraurethral (IU) alprostadil, including discussion of benefits and risks/burdens. (Conditional Recommendation; Evidence Level: Grade C) For men with ED who are considering the use of IU alprostadil, an in-office test should be performed. (Clinical Principle)
  • Men with ED should be informed regarding the treatment option of intracavernosal injections (ICI), including discussion of benefits and risks/burdens. (Moderate Recommendation; Evidence Level: Grade C)
  • For men with ED who are considering ICI therapy, an in-office injection test should be performed. (Clinical Principle)
  • Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens. (Strong Recommendation; Evidence Level: Grade C)
  • Men with ED who have decided on penile implantation surgery should be counseled regarding postoperative expectations. (Clinical Principle)
  • Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection. (Clinical Principle)
  • For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C)
  • Penile venous surgery is not recommended for men with ED. (Moderate Recommendation; Evidence Level: Grade C)
  • Low-intensity extracorporeal shock wave therapy (ESWT) should be considered investigational for ED. (Conditional Recommendation; Evidence Level: Grade C)
  • Intracavernosal stem cell therapy should be considered investigational for ED. (Conditional Recommendation; Evidence Level: Grade C)
  • Platelet-rich plasma (PRP) therapy should be considered experimental for ED. (Expert Opinion)