INTRODUCTION

The three major forms of male sexual dysfunction are erectile dysfunction, ejaculatory dysfunction, and decreased libido. Erectile dysfunction is a common problem in men over the age of 40 due to hormonal abnormalities, medications, psychological problems, neurologic disease, or vascular insufficiency. Men with this disorder experience significant psychological distress, which improves if treatment successfully restores erectile function [1]. Premature ejaculation may be another troublesome form of sexual dysfunction [2].

The treatment of male sexual dysfunction is reviewed here. Erectile physiology and the major causes of erectile dysfunction are discussed in detail elsewhere. (See "Overview of male sexual dysfunction" and "Evaluation of male sexual dysfunction".)

Guidelines from the American Urological Association (AUA) have been published for the treatment of erectile dysfunction [3] and premature ejaculation [2]. The American College of Physicians [4] and The American Association of Clinical Endocrinologists have also issued treatment guidelines [5].

GENERAL PRINCIPLES

The first step in the treatment of male sexual dysfunction is to determine the etiology. Certain clues in the history and appropriate laboratory testing can usually establish the primary cause (table 1). (See "Evaluation of male sexual dysfunction".)

Erectile dysfunction and cardiovascular disease share many risk factors, and their pathophysiology is mediated through endothelial dysfunction. Cardiovascular disease and its risk factors increase the risk for later erectile dysfunction (ED); on the other hand, erectile dysfunction may be an early warning sign of future cardiovascular events (see "Overview of male sexual dysfunction", section on 'Association with cardiovascular disease'). Lifestyle modifications such as diet and exercise, in addition to reducing cardiovascular risk factors, may improve ED as well. Cardiovascular risk factor reduction with pharmacotherapy may also improve ED.