Erectile Dysfunction

Main Article Content

Somboon Leungwattanakij, MD


Erectile dysfunction (ED) is an important issue in sexual relationships and can affect family and lead to other problems. Hence, ED treatments are widely acceptable with high efficacy rates and with low risks of adverse side effects at the present time. Physicians and healthcare workers should study and understand all mechanisms, history, family environment, underlying diseases for instance DM, hypertension and hypercholesterinemia. A better understanding of these underlying factors may help provide an appropriate consultation. The various treatments on offer include psycho- therapy and sex therapy. Medical therapy, mechanical devices, vascular surgery, combined therapy or others including topical PGE, gene therapy and testosterone are also available. Each case is different and the patient may select one or multiple kinds of treatment, suitable for them, whilst the physician may suggest or give guidelines to patients to help ensure the best clinical outcome.


Download data is not yet available.

Article Details

How to Cite
Leungwattanakij S. Erectile Dysfunction. BKK Med J [Internet]. 2019 Oct. 16 [cited 2023 Dec. 6];11(1):57. Available from:
Reviews Article


1. Hettiaratchy S, and Dziewulski P. ABC of burns Introduc- tion. BMJ 2004; 328:1366-1368.
2. NIH Consensus Development Panel on Impotence. JAMA 1993:270:83-90.
3. Feldman HA, Goldstein I, Hatzichristou DG, et al. Impo- tence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol 1994;151:54-61.
4. Tantiwong A. Epidemiology of erectile dysfunction: Prev- alence and risk factor. In: Ratana-Olarn K, Leungwat- tanakij S, eds. Erectile dysfunction. Bangkok: Beyond Enterprise, 2001:17-26.
5. Ignarro LJ, Buga GM, Wood KS, et al. Endothelium- derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci USA 1987; 84:9265-9.
6. Palmer RM, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium- derived relaxing factor. Nature 1987;327:524-6
7. Paick J, Lue TF. Anatomy of the penis. In: Hashmat A, Das S, eds. The penis. Philadelphia: Lea & Febiger, 1993:13.
8. Fischer C, Gross J, Zuch J. Cycle of penile erections synchronous with dreaming (REM) sleep: preliminary report. Arch Gen Psychiatry 1965;12:29-45
9. Mallick HN, Manchanda SK, Kumar VM. Sensory modulation of the medial preoptic area neuronal activity by dorsal penile nerve stimulation in rats. J Urol 1994;151:759-62
10. Melis MR, Argiolas A, Gessa GL. Evidence that apomor- phine induces penile erection and yawning by releasing oxytocin in the central nervous system. Eur J Pharmacol 1989;164:565-70
11. Vincent SR, Kimura H. Histochemical mapping of nitric oxide synthase in the rat brain. Neuroscience 1992;46:755-84.
12. Melis MR, Argiolas A. Nitric oxide synthase inhibitors prevent apomorphine- and oxytocin-induced penile erec- tion and yawning in male rats. Brain Res Bull 1993;32:71-4.
13. Leungwattanakij S, Flynn V, Hellstrom WJG. Intracav- ernous and intraurethral therapy for erectile dysfunction. Urol Clin of North Am 2001;28(2):343-54.
14. Moncada S, Palmer RM, Higgs EA. Nitric oxide: physi- ology, pathophysiology, and pharmacology. Pharmacol Rev 1991;43:109-42.
15. Bredt DS, Snyder SH. Nitric oxide, a novel neuronal messenger. Neuron 1992;8:3-11.
16. Knowles RG, Noncada S. Nitric oxide synthases in mammals.Biochem J 1994;298:249-58.
17. Sessa WC. The nitric oxide synthase family of proteins. J Vasc Res 1994;31:131-43.
18. Christ GJ, Moreno AP, Melman A, et al. Gap junction- mediated intercellular diffusion of Ca2 + in cultured human corporal smooth muscle cells. Am J Physiol 1992;263:C373-83.
19. Zusman RM, Morales A, Glasser DB, et al. Overall cardio- vascular profile of sildenafil citrate. Am J Cardiol 1999;83:35-44.
20. Goldstein I, Lue TF, Padma–Nathan H, et al. Oral silde- nafil in the treatment of erectile dysfunction. New Eng J Med 1998;338:1397-404.
21. Benet AE, Melman A.The epidemiology of erectile dysfunction. Urol Clin North Am 1995;22:699-709.
22. Rogers R, Meyer T, Lin CS, et al. Intracavernosal VEGF and AAA-VEGF gene prevent ED in a rat model of venous leakage impotence. Abstract presented in the 2000 Society for the Study of Impotence Fall Meeting, 2000.
23. Ratana-Olarn K. Impotence. In: Gojaseni P, Ratana-Olarn K, eds. Surgery of the urinary system and male genital organs, vol 2. Bangkok: Siam Stationary 1994: 226-251.
24. Buvat J, Lemaire A. Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy. J Urol 1997;158:1764-7.
25. Bradley WE, Timm GW, Gallagher JM, et al. New method for continuous measurement of nocturnal penile tumescence and rigidity. Urol 1985;26:4-9.
26. Rigiscan ambulatory rigidity and tumescence system. Document No.750-156-0486, Dacomed Corporation, Minneapolis, Minnesota, 1986.
27. Cilurzo P, Canale D, Turchi P, et al. The rigiscan system in the diagnosis of male sexual impotence. Arch Ital Urol Nefrol Androl 1992;64 (suppl 2):81-5.
28. Hattery RR, King BF Jr, Lewis RW, et al. Vasculogenic impotence. Duplex and color Doppler imaging. Radiol Clin North Am 1991;29:629-45.
29. Montorsi F, Guazzoni G, Barbieri L, et al. The effect of intracorporeal injection plus genital and audiovisual sexual stimulation versus second injection on penile color Doppler sonography parameters. J Urol 1996;155:536-40.
30. Zonszein J. Diagnosis and management of endocrine disorders of erectile dysfunction. Urol Clin North Am 1995;22:789-802.
31. Tantiwong A. Oral therapy for erectile dysfunction. In: Ratana-Olarn K, Leungwattanakij S, eds. Erectile dysfunction. Bangkok: Beyond Enterprise 2001:100-8.
32. Morales A, Gingell C, Colllins H, et al. Clinical safety of oral Sildenafil citrate in the treatment of erectile dysfunction. Int J Impot Res 1998;10:69-74.
33. Leungwattanakij S. Future trend of management of erectile dysfunction. In: Ratana-Olarn K, Leungwattanakij S, eds. Erectile dysfunction. Bangkok: Beyond Enterprise 2001:168-79.
34. Claes H, Sorgeloose T, Van Poppel H, et al. Int J Impot Res 2002;14 (Suppl 3):CP5.01.
35. Hellstrom WJ, Bennett AH, Gesundheit N, et al. A double-blind, placebo-controlled evaluation of the erectile response to transurethral alprostadil. Urol 1996;48:851-6.
36. Ruangdilokrat S. Intracavernosal injection therapy and intraurethral insertion. In: Ratana-Olarn K, Leungwat- tanakij S, eds. Erectile dysfunction. Bangkok: Beyond Enterprise 2001: 109-20.
37. Peterson CA, Bennett AH, Hellstrom WJ, et al. Erectile response to transurethral alprostadil, prazosin and alprostadil-prazosin combinations. J Urol 1998;159:1523-7.
38. Champion HC, Bivalacqua TJ, Wang R, et al. Induction of penile erection by intracavernosal and transurethral administration of novel nitric oxide donors in the cat. J Urol 1999;161:2013-9.
39. Marmar JL. Vacuum constriction devices. In: Hellstrom WJG, ed. Male infertility and sexual dysfunction. New York: Springer-Verlag 1997:409-24.
40. Kongkanan A, Leungwattanakij S. Surgical treatment of erectile dysfunction. In: Ratana-Olarn K, Leungwat- tanakij S, eds. Erectile dysfunction. Bangkok: Beyond Enterprise 2001: 121-58.
41. Carson CC. Complication of penile prosthesis and complex implantations. In: Carson CC, Kirby RS, Goldstein IW, eds. Textbook of erectile dysfunction. Oxford: Isis Medical Media 1999:435-49.
42. Nehra A, Jones WR, Hakim L, et al. Effectiveness of combination therapy of MUSE and Viagra in the salvage of erectile dysfunction patients desiring noninvasive therapy. Int J Impot Res 1999;11(Suppl1):C11.
43. Mydlo JH, Volpe MA, Macchia RJ. Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy. Eur Urol 2000;38:30-4.
44. Ho LV, Wang R, Mode DG, et al. Viagra and VCD. Int J Imp Res 1999;11(Suppl1):C10.
45. Kaplan SA, Reis RB, Kohn IJ, et al. Combination therapy using oral alpha-blockers and intracavernosal injection in men with erectile dysfunction. Urol 1998;52:739-43.
46. McVary KT, Polepalle S, Riggi S, et al. Topical prosta- glandin E1 SEPA gel for the treatment of erectile dysfunction. J Urol 1999;162:726-30.
47. Becher E, Borghi M, Momesso A, et al. Penile hemody- namic findings with a new topical formulation of alprostadil. J Urol 1998;159(5)(Suppl):A915.
48. Leungwattanakij S, Bryan W, Hellstrom WJG. Androgen deficiency in aging male. Mediguide to Urology 2000;13:1-7.
49. Ballard SA, Gingell CJ, Tang K, et al. Effects of sildenafil on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic nucleotide phosphodi- esterase isozymes. J Urol 1998;159(6):2164-71.
50. Phillips S, Gbekor E, Bethell S et al. Selectivity of Silde- nafiland other Phosphodiesterases Type 5 (PDE5) inhibi- tors against all human phosphodiesterase families. Euro Uro 2002;63 (Suppl.1):A244.
51. Hellstrom WJ, Hyun JS, Human L, et al. Antimicrobial activity of antibiotic-soaked, Resist trade mark-coated Bioflex®. Int J Impot Res 2003;15(1):18-21.
52. Porst H, Giuliano F, Glina S, et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5mg and 10mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, placebo- controlled trial. Eur Urol 2006;50:351-9.
53. Rajfer J, Aliotta PJ, Steidle CP, et al. Tadalafil dosed once a day in men with erectile dysfunction: a randomized, double-blind, placebo-controlled study in the US. Int J Impot Res 2007;19:95-103.
54. Roehrborn CG, McVary KT, Elion-Mboussa A, et al. Tadalafil administered once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a dose finding study. J Urol 2008;180:1228-34.
55. Hellstrom WJ, Kaminetsky J, Belkoff LH, et al. Efficacy of Avanafil 15 Minutes after Dosing in Men with Erectile Dysfunction: A Randomized, Double-Blind, Placebo Controlled Study. J Urol 2015;194:485-92.
56. Paick JS, Ahn TY, Choi HK, et al. Efficacy and safety of mirodenafil, a new oral phosphodiesterase type 5 inhibitor, for treatment of erectile dysfunction. J Sex Med 2008;5: 2672-80.
57. Salem EA, Kendirci M, Hellstrom WJ. Udenafil, a long- acting PDE5 inhibitor for erectile dysfunction. Curr Opin Investig Drugs 2006;7:661-9.
58. Knoll LD, Henry G, Culkin D, et al. Physician and patient satisfaction with the new AMS 700 momentary squeeze inflatable penile prosthesis. J Sex Med 2009;6:1773-8.