Evaluation and Management of Erectile Dysfunction in Clinical Practice

Erectile dysfunction (ED), defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance [1], is a common disorder that may affect 18 million men in the United States [2,3]. A meta-analysis of prevalence studies has demonstrated heterogeneous findings due to problems in reporting age categories, severity, and nomenclature [4]. Consistent with these findings, other studies have shown that prevalence rates vary by country or origin and ethnic group [5–9]. In the population-based National Health and Nutrition Examination Study (NHANES), almost 20% of all males and 75% of men older than 75 years reported ED [10]. This constitutes a significant psychological and public health burden. In 1998, almost 3400 out of 100,000 office visits by Medicare beneficiaries were related to ED [11]. Furthermore, annual expenditures in the United States for ED excluding pharmaceutical costs were $330 million in 2000; oral medication sales in 2005 amounted to $1.6 billion for sildenafil, $747 million for tadalafil, and $327 million for vardenafil [11]. Beyond the financial and social impact, studies have clearly demonstrated the negative impact of ED on health-related quality of life [12,13].