Introduction to erectile dysfunction

This topic discusses management of erectile dysfunction in individuals presumed male at birth, other than those undergoing (or who have had) gender-affirming hormones or gender-affirming surgery; see resources on sexual health relating to gender-affirming treatment on the TransHub website.

Healthcare providers are encouraged to use a sensitive approach that avoids assumptions about gender identity, sexual orientation or sexual practices.

For guidance on healthcare issues specific to individuals of diverse sexual orientation, see A guide to sensitive care for lesbian-gay-and bisexual people attending general practice at the Rainbow Health Victoria website.

Erectile dysfunction is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. In a survey of Australian males, 44% of those aged 45 years or older erectile dysfunction, and 17% reported complete dysfunction1. Erectile dysfunction is often accompanied by other sexual difficulties (eg premature ejaculation, low libido).

Note: Most erectile dysfunction has an organic cause.

About 80% of males who have erectile dysfunction have an organic cause (mainly neurovascular disease, diabetes or medication). Fewer than 20% of cases are psychogenic—this is more common at the beginning of the sexual experience. Consider screening for erectile dysfunction as part of routine consultations due to its prevalence and association with vascular disease.

Note: Consider screening for erectile dysfunction as part of routine consultations.

Risk factors for erectile dysfunction are:

  • increased age
  • cardiovascular disease and its risk factors including sedentary lifestyle, obesity, diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, smoking
  • endocrine disorders such as diabetes, androgen deficiency, thyroid disorders, hyperprolactinaemia
  • neurological conditions affecting the brain, spinal cord, or autonomic nervous system
  • medication (eg beta blockers, thiazides, antidepressants, antipsychotics, antiandrogens)
  • prostate cancer therapy
  • penile disorders (such as fibrous penile plaques in Peyronie disease)
  • recreational drug or alcohol use.
1 Weber MF, Smith DP, O'Connell DL, Patel MI, de Souza PL, Sitas F, et al. Risk factors for erectile dysfunction in a cohort of 108 477 Australian men. Med J Aust 2013;199(2):107-11.[URL]Return