Men's Health

Erectile Dysfunction (ED)

Erectile dysfunction (ED) is a medical condition that affects more than 30 million men in the United States. For some men, ED is mild, resulting in occasional problems getting or maintaining an erection. But for others, it's a more severe condition where problems with erections happen often–or always. In most cases, however, ED is treatable.

What Is ED?

  • Patient can't get an erection at all
  • Patient get an erection, but it's not hard enough for penetration
  • Patient get an erection, but he can't maintain it until sexual activity is over

Although many men have ED, not all of them experience it in the same way.

Evaluating ED

Evaluating erectile dysfunction (ED) is often dependent on having an open discussion with your patient and his partner about the patient's sexual health and how his erection problems may be affecting their sexual relationship. Despite increased awareness of ED as a medical condition that can be treated, many patients may not be comfortable broaching the topic of sexual health with you.
The evaluation for ED should include a medical and sexual history. In addition, the following may be considered1:

  • Interviews with the patient and his partner about how ED may be affecting their sexual relationship.
  • A focused physical examination and appropriate laboratory tests, including urinalysis, serum glucose, lipid profile, and testosterone levels
  • The presence of vascular risk factors, such as hypertension, diabetes, serum lipid abnormalities, smoking, and coronary artery disease
  • History of penile or pelvic trauma, chronic renal failure, radiation therapy, pelvic or genital surgery, and Peyronie's disease
  • A psychosocial examination

Once a diagnosis of ED is made, it is important to find a treatment that fits your patient's individual needs.

ED assessment quiz

An ED assessment quiz for patients can be a useful tool to provide an indication of whether, and to what extent, the patient is experiencing ED. To download and print an ED assessment quiz to use in your practice, click the link below. This quiz is not intended as a substitute for a complete evaluation, including a physical examination and medical history.

Please click the button below to download the Could it Be ED?Quiz
Could it Be ED?

Responses to each of the 5 questions are added together to arrive at a total score, ranging from 0 to 25, with higher scores indicating better sexual health.

ED Severity Classification

ED graph

If you like to understand something more about ED, please speak to your doctor or a urologist.

  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83-90.
  2. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.J Urol. 1994;151:54-61.
  3. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270:83-90.
  4. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Erectile Dysfunction. Accessed September 15, 2010.


Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia or BPH is a non-cancerous condition in which the prostate becomes enlarged and may cause problems associated with urination. Symptoms of BPH, such as needing to go frequently or urgently can increase with age and often occur along with erectile dysfunction (ED).

Common symptoms of BPH include1:

  • Needing to go frequently or urgently
  • Stopping or starting during urination
  • Needing to push or strain during urination
  • Having a weak urine stream
  • Incomplete emptying of the bladder
  • Nocturia, or needing to go excessively at night

These symptoms may be minor at first and may increase in severity over time.2,3

What Causes BPH and How It May Affect You

The kidneys filter waste products and water from the blood to form urine. After that, urine moves to the bladder, which stores it until it is full. From there, urine leaves the body through another thin tube, called the urethra, which is surrounded by the prostate gland. If everything is working normally, the bladder will empty all of the urine at once.

What happens with BPH is that the prostate gland enlarges. BPH can eventually interfere with urination when the enlarged prostate partially blocks the tube that drains the bladder. However, only your doctor can tell if you have BPH and not a more serious condition, like prostate cancer

BPH can also affect your quality of life through the following :

  • Decreased self-esteem4
  • Interference of symptoms on perceived sexuality5
  • Interference with daily activities6
  • Worry6
  • Embarrassment7
  • Effect on partner of lost sleep, disruption of social life, and inadequate sex life8

Link Between Erectile Dysfunction (ED) & BPH

There is a common association between Erectile Dysfunction (ED) and Benign Prostatic Hyperplasia (BPH).While there are a variety of risk factors which could result in men suffering from ED and/or BPH, studies have consistently demonstrated that age is one of the most important risk factor for ED as well as BPH, with prevalence of the two diseases increasing over older age group9,10. The risk factor for men who suffers from both ED and BPH also increases with age. In men who suffer from BPH, the prevalence of BPH can be up to 60%9, while in men who suffer from ED, the prevalence of ED can be as high as 70%11.

In all, more than 50% of men above the age of 50 suffer from both ED and BPH concomitantly12.

However, BPH is heavily under-recognized in men with ED. Patients are 45% less likely to be screened for BPH as they age and are 4 times more likely to diagnose for BPH.13

If you suspect that you suffer from both ED and BPH, seek medical advice from any of the clinics near you using Clinic Locator (Hyperlink to Clinic finder page)

Quick Answers To Common Questions About Living With BPH

What is the Prostate?

The prostate gland makes up the male sex organs. It is a walnut-sized gland weighing about 20 grams that is located below the male urinary bladder. The primary function of the prostate is to produce a thin milky fluid, which becomes a component of semen during ejaculation. Prostatic fluid contains prostate-specific antigen (PSA), a substance that helps liquefy the semen and contributes to sperm motility.14

Is BPH Common?

BPH, as well as ED is a very common men’s health problem. 50% of men with ED also have urinary symptoms associated with BPH14 while 70% of men over the age of 50 have urinary symptoms of BPH15.

Does age play a role in BPH?

Yes, the prevalence of BPH increases with age.

Remember that a man does not have to have an enlarged prostate to experience signs and symptoms of BPH.

What Causes BPH Symptoms?

BPH symptoms are associated with the obstruction of the urethra by the enlarged prostate. As the prostate grows larger, it may press on the urethra and/or bladder neck. As a result, the bladder wall becomes thicker and more irritable and contracts even when it is not full. Eventually, the bladder can weaken and lose the ability to completely empty.

Is BPH a Sign of Cancer?

No. BPH is a non-cancerous condition associate with abnormal prostate growth. Although BPH does not increase risk of prostate cancer, it is possible to have both BPH and prostate cancer. However, because early symptoms of both conditions are similar, see your doctor if you are experiencing any symptoms of urinary condition.

What Are the Risk Factors for BPH ?

Risk factors for BPH or enlarged prostate include aging, heredity, diabetes,16metabolic syndrome,17atherosclerosis.18

What Are The Possible Long-term Complications?

Urinary tract infections (UTIs)
Bladder stones
Acute urinary retention19

What Treatments are Available for BPH?

Several treatment options are available for BPH. Discuss with your doctor to see which one may be most suitable for you.

  1. Watchful waiting. For mild symptoms or if symptoms do not bother you, your doctor may suggest monitoring your disease and postponing drug intervention. Follow-ups should be done annually to determine changes that might warrant a different course of therapy.19
  2. Medicines. Different classes of medication are available to treat symptoms of BPH with or without the reduction in size of the prostate.
  3. Nonsurgical procedures. Several minimally invasive thermal or laser therapies are available to reduce prostate size or decrease obstruction of the urethra.
  4. Surgical treatment. If a patient with moderate to severe BPH fails to attain significant relief via medical or minimally-invasive therapies, surgical option is available to remove part or the entire prostate

Please click the button below to download the BPH Self-Assessment
BPH Self-Assessment

  1. Abrams P, Cardozo L, Fall M, et al. The Standardisation of terminology in lower urinary tract function: Report from the standardization sub-committee of the international continence society. Urology. 2003;61(1):37-49.
  2. Fitzpatrick JM. The natural history of benign prostatic hyperplasia. BJU Int. 2006;97(Suppl 2):3-6.
  3. Chute C, et al. The prevalence of prostatism; a population-based survey of urinary symptoms. Urology. 1993;150(1):85-9.
  4. Gannon K, Glover L, O’Neill M, Emberton M. Lower urinary tract symptoms inmen: self-perceptions and the concept of bother. BJU Int. 2005;96:823–827.
  5. Calais Da Silva F, Marquis P, Deschaseaux P, et al. Relative importance of sexuality and quality of life in patients with prostatic symptoms. Results of an international study. Eur Urol. 1997;31:272–280.
  6. Girman CJ, Epstein RS, Jacobsen SJ, et al. Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men. Urology. 1994;4:4825–431.
  7. Roberts RO, Rhodes T, Panser LA, et al. Natural history of prostatism: worry and embarrassment from urinary symptoms and health care-seeking behavior. Urology. 1994;43:621–628.
  8. Mitropoulos D, Anastasiou I, Giannopoulou C, et al. Symptomatic benign prostate hyperplasia: impact on partners’ quality of life. Eur Urol. 2002;41:240–245.
  9. Gacci M. et al Eur Urol. 2011;60(4):809-25
  10. Liu GF et al. In; Chatelain (ed). BPH International Consultation. Health Publication Ltd, 2001:19-57
  11. Braun MH, et al. Eur Urol. 2003;44 (5):588-94
  12. Rosen R et al. Lower Urinary Tract Symptoms and Male Sexual Dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003; 44(6):637-649
  13. McVary K, et al. Curr Med Res Opin 2008 Mar;24(3):775-84
  14. McKinley M, O'Loughlin V. Human Anatomy. 3rd ed. New York, NY: McGraw Hill; 2011:868.
  15. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH) Revised, 2010. ©2010 American Urological Association Education and Research, Inc.
  16. Sarma V, Kellog Parsons J. Diabetes and benign prostatic hyperplasia: emerging clinical connections.Curr Urol Rep. 2009;10(4):267-275.
  17. Hammarsten J, Hogstedt B, Holthuis N, et al. Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia.Prostate Cancer ProstaticDis. 1998;1(3):157-162.
  18. Berger AP, Bartsch G, Deibl M, et al. Atherosclerosis as a risk factor for benign prostatic hyperplasia. BJU Int. 2006;98(5):1038-1042.
  19. Kutikov A, Guzzo TJ, Malkowicz SB. Clinical Approach to the Prostate: An Update. Radiol Clin N Am.2006;44:649-663