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Erectile dysfunction

AUA-based evaluation of erectile dysfunction as a sexual-health and cardiovascular-risk marker, with staged shared treatment.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team · Clinical editorial review · reviewed 2026-08-20 · due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults with a consistent or recurrent inability to attain or maintain an erection sufficient for satisfactory sexual activity. Libido, orgasmic or ejaculatory disorders, penile deformity, infertility and gender-affirming sexual care may coexist but require their own evaluation.
sources for this section:AUA ED

The Bottom Line

  • Obtain a medical, sexual and psychosocial history, focused examination and selective laboratory tests; use a validated questionnaire to establish baseline severity and treatment response.
  • Counsel that erectile dysfunction is a risk marker for cardiovascular and other underlying disease and may justify evaluation or optimization beyond the sexual symptom itself.
  • Measure morning total testosterone and evaluate a confirmed low result under the applicable hypogonadism pathway rather than prescribing testosterone from symptoms alone.
  • Offer an FDA-approved PDE5 inhibitor unless contraindicated, explaining timing, stimulation, food effects and adequate trials; absolute nitrate interaction and hemodynamic risk must be addressed.
  • Discuss vacuum device, intraurethral or intracavernosal treatment and penile prosthesis as legitimate preference-sensitive options when tablets fail or are unsuitable, using trained instruction and realistic expectations.
sources for this section:AUA ED

Practical clinical workflow

1
Clarify onset, consistency, morning erections, masturbation, libido, relationship context, pain, curvature, pelvic surgery and medicine or substance exposure with inclusive, nonjudgmental language.
2
Review cardiovascular symptoms and risk, blood pressure, pulses, genital anatomy and neurologic clues; order glucose or A1C, lipids and morning testosterone when appropriate.
3
Address tobacco, alcohol, sleep, activity, diabetes, hypertension, depression and medication contributors while validating that these interventions complement—not delay—effective sexual treatment.
4
Teach correct PDE5-inhibitor use and reassess after an adequate trial, confirming product authenticity and avoiding unregulated “herbal” sexual products.
5
Refer complex disease, penile deformity, pelvic cancer treatment effects or refractory symptoms to urology and integrate psychosexual therapy when performance anxiety, distress or relationship factors matter.
sources for this section:AUA ED

Safety boundaries and escalation

  • Never combine a PDE5 inhibitor with nitrate therapy; review alpha blockers, blood pressure, cardiac stability and product-specific washout intervals.
  • Chest pain during sexual activity requires immediate cessation and emergency advice that a PDE5 inhibitor was taken so nitrates are not given inadvertently.
  • An erection lasting four hours or longer is a urologic emergency requiring immediate treatment to prevent permanent damage.
  • Sudden vision or hearing change after treatment needs urgent evaluation and discontinuation advice under the product label; counterfeit products add unpredictable risk.
sources for this section:AUA ED

Localization

The 2018 AUA guideline remains the listed US source, supplemented in practice by current FDA labels and cardiovascular consensus.
sources for this section:AUA ED

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American Urological AssociationErectile Dysfunction: AUA GuidelineJournal of Urology 200:633-641 · published 2018-09-01 · accessed 2026-08-20
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