A Practical Clinician’s Update on Erectile Impotence and its Management

SynopsisThe advance of knowledge has forced a change to many traditional concepts about impotence. More often than not, aetiology is multifactorial, the symptom of impotence being the end result of a variety of physical and psychological factors. Physical disease processes, especially penile vascular problems, are very frequently involved as causative factors. The physiology of erection is currently obscure and there are difficulties in logically attributing impotence to physical disease processes, psychological factors or chemical influences alone. Constitutional vulnerability may be important, as in psychosomatic medicine generally.The female partner’s genital structure and erotic skill can be significant factors often neglected in assessment.Opinions on management, particularly on pretreatment evaluation differ greatly, but much expensive and frequently unnecessary investigation can be bypassed by a logical pragmatic sequential approach. A practical management scheme is outlined.