An erection is an extremely complex mechanism, resulting from interactions between numerous components, any of which can lead to malfunction of the male sexual organ if disrupted.

In the healthy male, two different stimuli are involved in achieving an erection: tactile stimuli that are received by the penis and processed by peripheral nerves and spinal cord (the so-called reflexive erection) and those of a visual and perceptual nature elaborated by the cerebral cortex (the so-called psychogenic erection). If the nervous system is intact and there is a sufficient level of testosterone (the male hormone produced mainly by the testes), the stimuli induce an increase in blood flow to the penis, with consequent filling of the cavernous bodies and attainment of an erection.

Erectile dysfunction can occur at one or more points in this process; therefore, in order to guide the patient towards the most appropriate treatment it is important to determine whether the cause of the disorder is psychological or physical, and if physical, to determine whether it is hormonal, nervous, vascular, post-traumatic, anatomical, etc. The first andrological evaluation aims to determine whether the disorder is of physical or psychological origin and to conduct basic tests to exclude or confirm the most common causes.

If the patient have severe erectile dysfunction, it usually has a physical origin: in this case, the physician proceeds to evaluate the patient’s overall health, assessing conditions of obesity, diabetes, history of cardiovascular disorders, incorrect diet, nerve disorders, and hormonal deficiencies, after which it is decided whether to perform and which specific diagnostic tests should be done.

Suggested readings

  • Hatzimouratidis, K., Giuliano, F., Moncada, I., Muneer, A., Salonia, A., Verze, P., EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism, European Association of Urology, 2017, p. 13
  • Korenman, S.G., Epidemiology of erectile dysfunction, Endocrine, 2003.
  • Montague, D.K., Jarow, J.P., Broderick, G.A., Dmochowski, R.R., Heaton, J.P., Lue, T.F., Milbank, A.J., Nehra, A., Sharlip I.D., Chapter 1: The management of erectile dysfunction: an AUA update, Journal of Urology 2005.
arrow top