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44: ERECTILE DYSFUNCTION

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Impotence

ICD-9-CM CODE

  • 607.84 Impotence of organic origin

ICD-10-CM CODE

  • N52.9 Male erectile dysfunction, unspecified

PREFERRED PRACTICE PATTERN

  • As of June, 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology; therefore, associated or secondary musculoskeletal, cardiovascular/pulmonary, or potential neuromuscular patterns are indicated.

PATIENT PRESENTATION

A 60-year-old male patient with a history of type 2 diabetes, hypertension, and recent bilateral lower extremity weakness secondary to a motor vehicle accident, presents as increasingly withdrawn and without enthusiastic participation in his therapy. He is talking less and less, although he is complying with all instructions. When you address the changes observed, he states that his wife is unhappy with his sexual performance, complains that he does not find her attractive and he feels increasingly depressed. He loves his wife and finds her very sexy, but no matter how much he tries, he cannot always maintain an erection and at times is unable to get an erection at all.

KEY FEATURES

Description

  • 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, postoperative, chronic, or congenital/hereditary; related to medication or other pathology

Essentials of Diagnosis

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

  • Can have organic or psychosocial basis

    • Organic basis may be an early sign of cardiovascular disease

FIGURE 44-1

Algorithm for the evaluation and management of patients with ED. PDE, phosphodiesterase. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)

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General Considerations

  • Can result from spinal cord injury

  • Incidence increases with age

  • Psychological pathology

Demographics

  • Chronic erectile dysfunction (ED) affects1

    • Approximately 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

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

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • ED: Inability to form or maintain an erection

  • Premature ejaculation

  • Prostatic enlargement

  • Hypertension

  • Penile discharge

Functional Implications

  • Inability to procreate

  • Inability to have an erection, sexual dysfunction

FIGURE 44-2

Duplex ultrasonography and Doppler analysis of the arterial response to intracavernous papaverine injection. In ...

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