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Source: Lee M, Sharifi R. Erectile dysfunction. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed March 7, 2017.


  • Impotence.


  • Failure to achieve penile erection suitable for sexual intercourse.


  • Abnormality in system necessary for penile erection.

    • Organic erectile dysfunction (ED): vascular, nervous, or hormonal systems—80% of patients.

    • Psychogenic ED: psychological etiology.


  • Interconnected sinuses in two corpora cavernosa in penis fill with blood to produce erection.

  • Acetylcholine works with other neurotransmitters (ie, cyclic guanylate monophosphate, cyclic adenosine monophosphate, and vasoactive intestinal polypeptide) to produce penile arterial vasodilation and ultimately erection.

  • Organic ED associated with diseases that.

    • Compromise vascular flow to corpora cavernosum (eg, peripheral vascular disease, arteriosclerosis, and essential hypertension)

    • Impair nerve conduction to brain (eg, spinal cord injury and stroke)

    • Impair peripheral nerve conduction (eg, diabetes mellitus)

  • Secondary ED associated with hypogonadism.

  • Psychogenic ED associated with.

    • Malaise.

    • Reactive depression.

    • Performance anxiety.

    • Sedation.

    • Alzheimer disease.

    • Hypothyroidism.

    • Mental disorders.

  • Social habits (eg, cigarette smoking and excessive ethanol intake) and medications (Table 1) can also cause ED

TABLE 1.Medication Classes That Can Cause Erectile Dysfunction

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