What should be the focus of the medical and surgical history in the evaluation of erectile dysfunction (ED)?

Updated: Oct 14, 2020
  • Author: Edward David Kim, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Information should be obtained about any previous surgical procedures or other medical disorders. In particular, in addition to general medical information, any history of pelvic surgery, trauma, previous prostate surgery, or irradiation of the prostate should be elicited.

Inquiries should be made regarding cardiovascular risk factors, such as hypertension, diabetes, obesity, dyslipidemia, and family history of cardiac disease. For example, there is an established link between obesity and ED in men. [60]

The Princeton Consensus Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. It has the following two primary objectives:

  • To focus on evaluating and managing cardiovascular risk in men with ED and no known cardiovascular disease (CVD), with a particular emphasis on identifying those who may require additional cardiologic workup

  • To focus is on reevaluating and modifying previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD

The Second Princeton Consensus suggests that men with ED and no obvious cause are at high risk for subclinical coronary artery disease (CAD) and should undergo, at the least, screening for blood glucose and lipids and blood pressure measurement. [61]

The Third Princeton Consensus focuses on (1) emphasizing the use of exercise ability and stress testing to ensure that each man’s cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED and (2) highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. [8]

ED has been demonstrated to be a harbinger of potential future cardiovascular events. [57] The development of ED has proved to be a precursor to symptomatic CAD in men, with an average lead-time of 38.8 months. [62] Since 2005, several observational studies have shown a strong correlation between ED and CAD, and subsequent large longitudinal studies have demonstrated that men with ED have a 65-85% increased risk of subsequent CAD. [63]

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