Erectile dysfunction

• ED
• Impotence

• 607.84 Impotence of organic origin

• N52.9 Male erectile dysfunction, unspecified

• 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.

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, post-operative, chronic, or congenital/hereditary; related to medication or other pathology

Essentials of Diagnosis

• 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

General Considerations

• Can result from spinal cord injury
• Incidence increases with age
• Psychological pathology

Demographics

• 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

Signs and Symptoms

• Erectile dysfunction; 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

Possible Contributing Causes

• 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

Differential Diagnosis

• Cancer
• Enlarged prostate

Laboratory Tests

• Pathogen identification
• Complete blood count
• Urinalysis
• Lipid profile

Imaging

• Radiography for spine involvement
• CT and MRI for spinal involvement, tumor
• Ultrasound
• Abdominal scans for possible tumor

Diagnostic Procedures

• 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

Medication

• Discontinue medications that may be causal
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