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Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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Justin J. Badal, MD, Department of Urology, University of California Davis, Sacramento, California
Genevieve Sweet, MD, Department of Urology, Sutter Medical Group, Roseville, California
Shelley Godley, MD, Department of Urology, Veterans Affairs Northern California Health Care System, Sacramento, California
Stanley A. Yap, MD, Department of Urology, University of California Davis, Sacramento, California and Department of Urology, Veterans Affairs Northern California Health Care System, Sacramento, California
Dana Nanigian, MD, Chief of Urology, Department of Urology, Veterans Affairs Northern California Health Care System, Sacramento, California.

Abstract
Erectile dysfunction (ED) is one of the most common sexual disorders affecting men. Discussion regarding erectile function, diagnosis, and management of the disease typically begins at the primary care level. A broad understanding of the basic causative factors and initial treatment regimens gives primary care physicians the ability to treat ED. An enhanced understanding of surgical options allows for referrals to be made to urologists for advanced surgical treatment of ED in patients who have failed medical therapies. Initial diagnosis and continued workup can be performed prior to consultation with a surgical specialist. Detailed here are different causes of ED as well as their respective studies to enhance initial surgical evaluation.
Key Words: erectile dysfunction, diagnosis, management, treatment.

Introduction
Background
Erectile Dysfunction (ED) is defined as persistent difficulty attaining and/or maintaining a penile erection sufficient for satisfactory sexual intercourse.1 ED is estimated to affect 18-30 million men in the United States.2 Additional issues of premature ejaculation, decreased libido, infertility or other sexual concerns may complicate the diagnosis and management of ED.3,4 ED may exert a substantial emotional toll on men and their sexual partner with regard to sexual dissatisfaction, relationship intimacy, and concerns about procreation.5,6

The predicted number of men with ED is 322 million by the year 2025, compared to approximately 152 million men in 1995.7 ED tends to be a diagnosis of older men, however it may be found across age groups. A cross-sectional interview survey of 1,410 men aged 18-59 years, reported a 7-11% prevalence of ED in men 18-49 years of age.7 Evaluation of ED may facilitate recognition of other important comorbidities, most particularly vascular disease. Men with ED are at markedly increased risk of serious cardiac disease, cardiac events and mortality compared to men without ED, and the vast majority have at least one cardiovascular risk factor.8