Erectile dysfunction or impotency affects 18 to 20 million men every year in the United States. However, there has been a great change in treatment since 1998 when the first successful oral form of therapy, sildenafil citrate, was introduced. In addition, studies have shown that most cases of ED have organic rather than psychological causes.


ED, or impotence, is the inability to obtain or maintain an erection satisfactory for sexual intercourse. It is different from ejaculatory dysfunction although the two may be indirectly related.


Diagnosis will include a detailed history and a comprehensive physical examination with emphasis on thyroid, penis, testis and circulation in the lower extremities. There are many causes of ED, both psychological and physiological, but advances in therapy have greatly enhanced the probabilities of successful treatment.

The two most common organic causes of ED are diabetes mellitus and vascular diseases related to atherosclerosis. Risk factors for vascular diseases include hypertension, hyperlipidemia, and coronary artery disease. Medications are also a very common cause of ED.

Drugs Associated with Erectile Dysfunction

Drugs that can cause erectile dysfunction include legal and illegal substances, pain medications, and prescription medications for a number of medical disorders.

Legal Recreational Drugs

  • Alcohol
  • Cigarettes and tobacco

Illegal Recreational Drugs

  • Cocaine
  • Marijuana
  • Narcotics

Anxiety and Depression

  • Antidepressants
  • Psychotropic medications

Fungal Infections

  • Ketoconazole

Gastrointestinal Disorders

  • Anticholinergics
  • H2 blockers

Heart Disease/High Blood Pressure

  • Antihypertensives (symphatholytics)
  • Beta blockers
  • Clofibrate
  • Spironolactone


  • Antiandrogens
  • Estrogens

Nausea and Vomiting

  • Phenothiazines

Pain Management

  • Narcotics

Respiratory Disorders

  • Anticholinergics

Treatment Options

A major advance in treatment of organic erectile dysfunction was the introduction in 1998 of sildenafil citrate. Patients who fail to respond to oral medications may benefit from use of a vacuum constriction device, intracavernous injections, or intraurethral suppositories. For patients whose ED follows a radical prostatectomy, surgical implantation of a penile prosthesis may be the answer.