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Chapter 24
Erectile Dysfunction
Caroline Kang and James Kashanian
Case
A 64-year-old male with hypertension and hyperlipidemia presented for evaluation of worsening erectile function. Over the past 5–6 years he noted a decrease in erectile function. Currently, with sexual or self-stimulation, his rigidity is 60% (70% being rigid enough for penetrative intercourse). Additionally, he has been unable to maintain his erection. He is married to a 63-year-old female, and they report being intimate once per week and he masturbates once per week. He lacks nocturnal and morning erections. He denies penile curvature or decreased sensation of orgasm, and ejaculate volume is unchanged. He also denies hematospermia or pain during ejaculation. Lastly, he denies any abnormalities in energy, libido, concentration, or mood.
He takes lisinopril and atorvastatin daily. He is not taking nitrates nor has he ever required nitrates for chest pain in the past. He has good exercise tolerance and walks 2 miles daily. His surgical history consists of knee replacement. He denies any urological complaints or trauma to the groin or pelvis. His family history is notable for hypertension in his father but negative for cardiovascular disease or stroke. He has one healthy 30-year-old daughter.
Physical exam showed normal vital signs, a BMI of 29.0, and a well-nourished male. He has normal body hair growth pattern. He has no gynecomastia. Genital exam revealed a circumcised penis, orthotopic urethral meatus, no glans or penile shaft lesions. Pubic hair distribution was normal. Scrotal exam was unremarkable
C. Kang
Urology, Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
J. Kashanian (*)
Urology and Reproductive Medicine, Male Sexual Health, Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
e-mail: jak9111@med.cornell.edu
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P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_24