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Condition/Disorder Synonyms

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  • ED

  • Impotence

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ICD-9-CM Code

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  • 607.84 Impotence of organic origin

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ICD-10-CM Code

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  • N52.9 Male erectile dysfunction, unspecified

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Preferred Practice Pattern

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  • As of November 2012, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns are indicated.

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Key Features

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Description

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  • Inability to perform sexually; inability to form an erection

  • Loss of erection from arterial, venous, neurogenic, or psychological reasons

  • Physical therapists treat secondary problems: weakness, gait abnormalities, limited aerobic endurance

  • May be acute, post-operative, chronic, or congenital/hereditary; related to medication or other pathology

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Essentials of Diagnosis

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  • Diagnosis usually based on history; need for targeted diagnostic procedures if neurogenic causes suspected

  • Can have organic or psychosocial basis

    • Organic basis may be early sign of cardiovascular disease

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General Considerations

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  • Can result from spinal cord injury

  • Incidence increases with age

  • Psychological pathology

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Demographics

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  • Chronic ED affects1

    • 4% of men in their 50s

    • Approximately 17% of men in their 60s

    • Approximately 47% of men over the age of 75 years

  • Transient ED and inadequate erection

    • Affect approximately 50% of men between the ages of 40 and 70 years

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Clinical Findings

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Signs and Symptoms

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  • Erectile dysfunction; inability to form or maintain an erection

  • Premature ejaculation

  • Prostatic enlargement

  • Hypertension

  • Penile discharge

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Functional implications

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  • Inability to procreate

  • Inability to have an erection, sexual dysfunction

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Possible Contributing Causes

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  • Urinary tract infection (bacterial or viral)

  • Diabetes (type I or II) and associated medications

  • Enlarged prostate

  • Cardiac and hypertension medications

  • Antihypertensive and antidepressant medications

  • Damage to nerves, such as with multiple sclerosis, Parkinson's, trauma

  • Weak pelvic floor muscles

  • Smoking (cancer-related)

  • Occupational exposures

  • Tumors (benign or metastatic)

  • Metastases

  • Age

  • Spinal cord injury or neuromuscular pathology, such as stroke

  • Neuropathy

  • Post-surgical scarring or adhesions

  • Side-effect of cancer treatment: radiation, chemotherapy, surgery

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Differential Diagnosis

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  • Cancer

  • Enlarged prostate

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Pathogen identification

  • Complete blood count

  • Urinalysis

  • Lipid profile

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Imaging

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  • Radiography for spine involvement

  • CT and MRI for spinal involvement, tumor

  • Ultrasound

  • Abdominal scans for possible tumor

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Diagnostic Procedures

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  • Palpation for differential diagnosis

    • Kidneys: in supine, place one hand under client between ribs and iliac crest, other hand on abdomen below ribs and ribs pointing in opposite direction: +/- tenderness or reproduction of symptoms

    • Bladder (not usually palpable unless distended and raised above pubic bone): in supine, ...

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