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  • ED
  • Impotence

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  • 607.84 Impotence of organic origin

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  • N52.9 Male erectile dysfunction, unspecified

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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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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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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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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, place hand above pubis, press down: +/- tenderness, reproduction of pain, or ability to feel the bladder: __+ __-
  • Electromyography

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Medication

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  • Discontinue medications that may be causal

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Medical Procedures

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  • Penile surgical implants
  • ...

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