Advances in the Causality, Diagnosis and Management of Erectile Dysfunction
Research Article
Open Access
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Advances in the Causality, Diagnosis and Management of Erectile Dysfunction

Yuanzhou Wang 1*
1 The University of Sydney
*Corresponding author: ywan0106@uni.sydney.edu.au
Published on 2 October 2025
Journal Cover
TNS Vol.140
ISSN (Print): 2753-8826
ISSN (Online): 2753-8818
ISBN (Print): 978-1-80590-399-4
ISBN (Online): 978-1-80590-400-7
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Abstract

Penile erection demonstrates how psychological influences and hormonal balance modulate microcirculation. It results from a highly coordinated neurovascular process involving the integration and synchronisation of vascular endothelium, smooth muscle, and psychological, neurological, and endocrine systems. Therefore, the proper functioning of these processes is essential for maintaining penile flaccidity or achieving an erection, whereas disturbances in any component can result in erectile dysfunction (ED). ED is a common health condition with a substantial impact on men’s quality of life worldwide. Currently, this disease is considered a multifactorial condition involving a complex interplay of social, psychological, and physiological factors, necessitating the adoption of multiple treatment strategies. This paper offers an overview of the mechanisms of erections, etiological factors contributing to ED—including psychological, neurological, endocrinological, and vasculogenic aspects—diagnostic approaches and treatments.

Keywords:

Erectile dysfunction, Etiology, Diagnosis, Treatment, Sexual health

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Wang,Y. (2025). Advances in the Causality, Diagnosis and Management of Erectile Dysfunction. Theoretical and Natural Science,140,14-21.

References

[1]. National Institutes of Health. Consensus development conference statement on impotence. Int J Impot Res. 1993 Dec 7; 5: 181-284.

[2]. Nicolosi A, Moreira Jr ED, Shirai M, Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003 Jan 1; 61(1): 201-6.

[3]. Kimura M, Murata Y, Shimoda K, Robinson RG. Sexual dysfunction following stroke. Comprehensive psychiatry. 2001 May 1; 42(3): 217-22.

[4]. Courtois FJ, Charvier KF, Leriche A, Raymond DP. Sexual function in spinal cord injury men. I. Assessing sexual capability. Spinal Cord. 1993 Dec; 31(12): 771-84.

[5]. Traish AM, Goldstein I, Kim NN. Testosterone and erectile function: from basic research to a new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. European Urology. 2007 Jul 1; 52(1): 54-70.

[6]. Armagan A, Kim NN, Goldstein I, Traish AM. Dose—response relationship between testosterone and erectile function: evidence for the existence of a critical threshold. Journal of Andrology. 2006 Jul 8; 27(4): 517-26.

[7]. Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, Jannini EA. Multicenter Study on the Prevalence of Sexual Symptoms in Male Hypo- and Hyperthyroid Patients. The Journal of Clinical Endocrinology & Metabolism. 2005; 90(12): 6472-9.

[8]. Paick JS, Yang JH, Kim SW, Ku JH. The role of prolactin levels in the sexual activity of married men with erectile dysfunction. BJU international. 2006 Dec; 98(6): 1269-73.

[9]. Menezes A, Artham S, Lavie CJ, Milani RV, O'Keefe J. Erectile dysfunction and cardiovascular disease. Postgraduate Medicine. 2011 May 1; 123(3): 7-16.

[10]. Jacobs MC, Lenders JW, Kapma JA, Smits P, Thien T. Effect of chronic smoking on endothelium-dependent vascular relaxation in humans. Clinical Science. 1993 Jul 1; 85(1): 51-5.

[11]. Meldrum DR, Gambone JC, Morris MA, Meldrum DA, Esposito K, Ignarro LJ. The link between erectile and cardiovascular health: the canary in the coal mine. The American journal of cardiology. 2011 Aug 15; 108(4): 599-606.

[12]. Miner MM. Erectile dysfunction: a harbinger or consequence: does its detection lead to a window of curability?. Journal of andrology. 2011 Mar 4; 32(2): 125-34.

[13]. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10; 140(11): e596-646.

[14]. Chrysant SG. Antihypertensive therapy causes erectile dysfunction. Current Opinion in Cardiology. 2015 Jul 1; 30(4): 383-90.

[15]. Parthasarathy HK, Ménard J, White WB, Young Jr WF, Williams GH, Williams B, Ruilope LM, McInnes GT, Connell JM, MacDonald TM. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. Journal of hypertension. 2011 May 1; 29(5): 980-90.

[16]. Corona G, Ricca V, Bandini E, Mannucci E, Lotti F, Boddi V, Rastrelli G, Sforza A, Faravelli C, Forti G, Maggi M. Selective serotonin reuptake inhibitor-induced sexual dysfunction. The journal of sexual medicine. 2009 May; 6(5): 1259-69.

[17]. Trinchieri M, Trinchieri M, Perletti G, Magri V, Stamatiou K, Cai T, et al. Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review. The Journal of Sexual Medicine. 2021; 18(8): 1354-63.

[18]. Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard operating procedures for taking a sexual history. The journal of sexual medicine. 2013 Jan; 10(1): 26-35.

[19]. Hatzichristou D, Rosen RC, Derogatis LR, Low WY, Meuleman EJ, Sadovsky R, Symonds T. Recommendations for the clinical evaluation of men and women with sexual dysfunction. The journal of sexual medicine. 2010 Jan; 7(1_Part_2): 337-48.

[20]. MacDonald SM, Burnett AL. Physiology of erection and pathophysiology of erectile dysfunction. Urologic Clinics. 2021 Nov 1; 48(4): 513-25.

[21]. Najari BB, Kashanian JA. Erectile dysfunction. Jama. 2016 Nov 1; 316(17): 1838-.

[22]. Amin KM, El-Badry OM, Abdel Rahman DE, Abdellattif MH, Abourehab MA, El-Maghrabey MH, Elsaid FG, El Hamd MA, Elkamhawy A, Ammar UM. Scaffold repurposing reveals new nanomolar phosphodiesterase type 5 (pde5) inhibitors based on pyridopyrazinone scaffold: Investigation of in vitro and in silico properties. Pharmaceutics. 2022 Sep 15; 14(9): 1954.

[23]. Bobin P, Belacel-Ouari M, Bedioune I, Zhang L, Leroy J, Leblais V, Fischmeister R, Vandecasteele G. Cyclic nucleotide phosphodiesterases in heart and vessels: a therapeutic perspective. Archives of cardiovascular diseases. 2016 Jun 1; 109(6-7): 431-43.

[24]. Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. The Journal of urology. 1996 Mar 1; 155(3): 802-15.

[25]. Belew D, Klaassen Z, Lewis RW. Intracavernosal injection for the diagnosis, evaluation, and treatment of erectile dysfunction: a review. Sexual medicine reviews. 2015 Mar; 3(1): 11-23.

[26]. Zhang J, Zhou W, Zhang Y, Zhang W, Zhang C. A novel method to quantify penile arterial blood supply using shear wave elastography during penile duplex ultrasound in men with erectile dysfunction. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022; 28: e935232-1.

[27]. Tang Q, Chen C, Wang X, Li W, Zhang Y, Wang M, Jing W, Wang H, Guo W, Tian W. Botulinum toxin A improves adipose tissue engraftment by promoting cell proliferation, adipogenesis and angiogenesis. International journal of molecular medicine. 2017 Sep 1; 40(3): 713-20.

[28]. El‐Shaer W, Ghanem H, Diab T, Abo‐Taleb A, Kandeel W. Intra‐cavernous injection of BOTOX®(50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial. Andrology. 2021 Jul; 9(4): 1166-75.

[29]. Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, Breda G, Silvestre P, Giammusso B, Morgia G, Graziottin A. AMS three–piece inflatable implants for erectile dysfunction: a long–term multi–institutional study in 200 consecutive patients. European urology. 2000 Jan 27; 37(1): 50-5.

[30]. Kohn TP, Rajanahally S, Hellstrom WJ, Hsieh TC, Raheem OA. Global trends in prevalence, treatments, and costs of penile prosthesis for erectile dysfunction in men. European Urology Focus. 2022 May 1; 8(3): 803-13.

[31]. Lee DJ, Najari BB, Davison WL, Al Awamlh BA, Zhao F, Paduch DA, Mulhall JP, Chughtai B, Lee RK. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. The journal of sexual medicine. 2015 Jul; 12(7): 1638-45.

[32]. Daeschler SC, Harhaus L, Schoenle P, Boecker A, Kneser U, Bergmeister KD. Ultrasound and shock-wave stimulation to promote axonal regeneration following nerve surgery: a systematic review and meta-analysis of preclinical studies. Scientific reports. 2018 Feb 16; 8(1): 3168.

[33]. Usta MF, Gabrielson AT, Bivalacqua TJ. Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review. International Journal of Impotence Research. 2019 May; 31(3): 231-8.

[34]. La Croce G, Schifano N, Pescatori E, Caraceni E, Colombo F, Bettocchi C, Carrino M, Vitarelli A, Pozza D, Fiordelise S, Varvello F. Which patient may benefit the most from penile prosthesis implantation?. Andrology. 2022 Nov; 10(8): 1567-74.

References

[1]. National Institutes of Health. Consensus development conference statement on impotence. Int J Impot Res. 1993 Dec 7; 5: 181-284.

[2]. Nicolosi A, Moreira Jr ED, Shirai M, Tambi MI, Glasser DB. Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology. 2003 Jan 1; 61(1): 201-6.

[3]. Kimura M, Murata Y, Shimoda K, Robinson RG. Sexual dysfunction following stroke. Comprehensive psychiatry. 2001 May 1; 42(3): 217-22.

[4]. Courtois FJ, Charvier KF, Leriche A, Raymond DP. Sexual function in spinal cord injury men. I. Assessing sexual capability. Spinal Cord. 1993 Dec; 31(12): 771-84.

[5]. Traish AM, Goldstein I, Kim NN. Testosterone and erectile function: from basic research to a new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. European Urology. 2007 Jul 1; 52(1): 54-70.

[6]. Armagan A, Kim NN, Goldstein I, Traish AM. Dose—response relationship between testosterone and erectile function: evidence for the existence of a critical threshold. Journal of Andrology. 2006 Jul 8; 27(4): 517-26.

[7]. Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, Jannini EA. Multicenter Study on the Prevalence of Sexual Symptoms in Male Hypo- and Hyperthyroid Patients. The Journal of Clinical Endocrinology & Metabolism. 2005; 90(12): 6472-9.

[8]. Paick JS, Yang JH, Kim SW, Ku JH. The role of prolactin levels in the sexual activity of married men with erectile dysfunction. BJU international. 2006 Dec; 98(6): 1269-73.

[9]. Menezes A, Artham S, Lavie CJ, Milani RV, O'Keefe J. Erectile dysfunction and cardiovascular disease. Postgraduate Medicine. 2011 May 1; 123(3): 7-16.

[10]. Jacobs MC, Lenders JW, Kapma JA, Smits P, Thien T. Effect of chronic smoking on endothelium-dependent vascular relaxation in humans. Clinical Science. 1993 Jul 1; 85(1): 51-5.

[11]. Meldrum DR, Gambone JC, Morris MA, Meldrum DA, Esposito K, Ignarro LJ. The link between erectile and cardiovascular health: the canary in the coal mine. The American journal of cardiology. 2011 Aug 15; 108(4): 599-606.

[12]. Miner MM. Erectile dysfunction: a harbinger or consequence: does its detection lead to a window of curability?. Journal of andrology. 2011 Mar 4; 32(2): 125-34.

[13]. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Sep 10; 140(11): e596-646.

[14]. Chrysant SG. Antihypertensive therapy causes erectile dysfunction. Current Opinion in Cardiology. 2015 Jul 1; 30(4): 383-90.

[15]. Parthasarathy HK, Ménard J, White WB, Young Jr WF, Williams GH, Williams B, Ruilope LM, McInnes GT, Connell JM, MacDonald TM. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. Journal of hypertension. 2011 May 1; 29(5): 980-90.

[16]. Corona G, Ricca V, Bandini E, Mannucci E, Lotti F, Boddi V, Rastrelli G, Sforza A, Faravelli C, Forti G, Maggi M. Selective serotonin reuptake inhibitor-induced sexual dysfunction. The journal of sexual medicine. 2009 May; 6(5): 1259-69.

[17]. Trinchieri M, Trinchieri M, Perletti G, Magri V, Stamatiou K, Cai T, et al. Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review. The Journal of Sexual Medicine. 2021; 18(8): 1354-63.

[18]. Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard operating procedures for taking a sexual history. The journal of sexual medicine. 2013 Jan; 10(1): 26-35.

[19]. Hatzichristou D, Rosen RC, Derogatis LR, Low WY, Meuleman EJ, Sadovsky R, Symonds T. Recommendations for the clinical evaluation of men and women with sexual dysfunction. The journal of sexual medicine. 2010 Jan; 7(1_Part_2): 337-48.

[20]. MacDonald SM, Burnett AL. Physiology of erection and pathophysiology of erectile dysfunction. Urologic Clinics. 2021 Nov 1; 48(4): 513-25.

[21]. Najari BB, Kashanian JA. Erectile dysfunction. Jama. 2016 Nov 1; 316(17): 1838-.

[22]. Amin KM, El-Badry OM, Abdel Rahman DE, Abdellattif MH, Abourehab MA, El-Maghrabey MH, Elsaid FG, El Hamd MA, Elkamhawy A, Ammar UM. Scaffold repurposing reveals new nanomolar phosphodiesterase type 5 (pde5) inhibitors based on pyridopyrazinone scaffold: Investigation of in vitro and in silico properties. Pharmaceutics. 2022 Sep 15; 14(9): 1954.

[23]. Bobin P, Belacel-Ouari M, Bedioune I, Zhang L, Leroy J, Leblais V, Fischmeister R, Vandecasteele G. Cyclic nucleotide phosphodiesterases in heart and vessels: a therapeutic perspective. Archives of cardiovascular diseases. 2016 Jun 1; 109(6-7): 431-43.

[24]. Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. The Journal of urology. 1996 Mar 1; 155(3): 802-15.

[25]. Belew D, Klaassen Z, Lewis RW. Intracavernosal injection for the diagnosis, evaluation, and treatment of erectile dysfunction: a review. Sexual medicine reviews. 2015 Mar; 3(1): 11-23.

[26]. Zhang J, Zhou W, Zhang Y, Zhang W, Zhang C. A novel method to quantify penile arterial blood supply using shear wave elastography during penile duplex ultrasound in men with erectile dysfunction. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022; 28: e935232-1.

[27]. Tang Q, Chen C, Wang X, Li W, Zhang Y, Wang M, Jing W, Wang H, Guo W, Tian W. Botulinum toxin A improves adipose tissue engraftment by promoting cell proliferation, adipogenesis and angiogenesis. International journal of molecular medicine. 2017 Sep 1; 40(3): 713-20.

[28]. El‐Shaer W, Ghanem H, Diab T, Abo‐Taleb A, Kandeel W. Intra‐cavernous injection of BOTOX®(50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial. Andrology. 2021 Jul; 9(4): 1166-75.

[29]. Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, Breda G, Silvestre P, Giammusso B, Morgia G, Graziottin A. AMS three–piece inflatable implants for erectile dysfunction: a long–term multi–institutional study in 200 consecutive patients. European urology. 2000 Jan 27; 37(1): 50-5.

[30]. Kohn TP, Rajanahally S, Hellstrom WJ, Hsieh TC, Raheem OA. Global trends in prevalence, treatments, and costs of penile prosthesis for erectile dysfunction in men. European Urology Focus. 2022 May 1; 8(3): 803-13.

[31]. Lee DJ, Najari BB, Davison WL, Al Awamlh BA, Zhao F, Paduch DA, Mulhall JP, Chughtai B, Lee RK. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. The journal of sexual medicine. 2015 Jul; 12(7): 1638-45.

[32]. Daeschler SC, Harhaus L, Schoenle P, Boecker A, Kneser U, Bergmeister KD. Ultrasound and shock-wave stimulation to promote axonal regeneration following nerve surgery: a systematic review and meta-analysis of preclinical studies. Scientific reports. 2018 Feb 16; 8(1): 3168.

[33]. Usta MF, Gabrielson AT, Bivalacqua TJ. Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review. International Journal of Impotence Research. 2019 May; 31(3): 231-8.

[34]. La Croce G, Schifano N, Pescatori E, Caraceni E, Colombo F, Bettocchi C, Carrino M, Vitarelli A, Pozza D, Fiordelise S, Varvello F. Which patient may benefit the most from penile prosthesis implantation?. Andrology. 2022 Nov; 10(8): 1567-74.

Cite this article

Wang,Y. (2025). Advances in the Causality, Diagnosis and Management of Erectile Dysfunction. Theoretical and Natural Science,140,14-21.

Data availability

The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

About volume

Volume title: Proceedings of ICBioMed 2025 Symposium: Interdisciplinary Frontiers in Pharmaceutical Sciences

ISBN: 978-1-80590-399-4(Print) / 978-1-80590-400-7(Online)
Editor: Alan Wang, Xiangdong Xue
Conference website: https://www.icbiomed.org/shanghai.html
Conference date: 11 September 2025
Series: Theoretical and Natural Science
Volume number: Vol.140
ISSN: 2753-8818(Print) / 2753-8826(Online)

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