A treatment algorithm for healthy young men with erectile dysfunction

BJU Int. 2019 Jan;123(1):173-179. doi: 10.1111/bju.14458. Epub 2018 Aug 28.


Objectives: To assess baseline characteristics of a cohort of young men with erectile dysfunction (ED) but no identifiable organic cause and to evaluate the efficacy of our treatment algorithm.

Patients and methods: We retrospectively reviewed the charts of men aged <40 years referred to our tertiary care centre for evaluation and treatment of their ED between March 2010 and August 2016. Of 185 men reviewed, we included 73 men who were identified as having no identifiable organic cause for their ED and had successfully completed a detailed questionnaire regarding their medical and sexual history at the initial consultation. The questionnaire was used to obtain baseline patient characteristics and identify comorbid conditions which may predispose to ED. For these men, our standard treatment comprised a daily low-dose phosphodiesterase type 5-inhibitor along with a referral for psychosexual therapy, with the option of more invasive treatment if this initial approach failed. After a minimum of 6 months of treatment, patients were asked to complete a follow-up questionnaire via phone or e-mail. Thirty-three men successfully completed the follow-up questionnaire. Pre- and post-treatment questionnaires were compared to determine treatment adherence and efficacy.

Results: The mean (range) age of the study cohort was 31.9 (22-39) years. At the initial consultation, 85% of men (n = 62) reported problems obtaining an erection. After a minimum of 6 months of treatment, only 42% reported the same problem (n = 14), with 58% (n = 19) satisfied with their erectile function. Post-treatment International Index of Erectile Function (IIEF) scores showed a significant improvement in erectile function (18.8 vs 13.3; P < 0.01), orgasmic function (7.7 vs 6.2; P = 0.01) and overall satisfaction (6.1 vs 4.5; P < 0.01). No statistically significant improvement was noted in sexual desire or intercourse satisfaction.

Conclusions: Our proposed treatment approach for men with ED aged < 40 years without an identifiable organic aetiology appears to be a reasonable and effective first-line approach, as demonstrated by significantly improved post-treatment IIEF scores and patient-reported outcomes. This algorithm can provide urologists with a useful framework for managing these potentially challenging patients.

Keywords: #ErectileDysfunction; psychosexual therapy; treatment, PDE-5 inhibitor; young men.

MeSH terms

  • Adolescent
  • Adult
  • Algorithms*
  • Coitus
  • Ejaculation
  • Erectile Dysfunction / physiopathology
  • Erectile Dysfunction / therapy*
  • Humans
  • Male
  • Orgasm
  • Patient Compliance
  • Personal Satisfaction
  • Phosphodiesterase 5 Inhibitors / administration & dosage
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Psychotherapy*
  • Retrospective Studies
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult


  • Phosphodiesterase 5 Inhibitors