erectile dysfunction causes

Most men with end-stage renal disease (ESRD) experience sexual dysfunction.  Manifestations can include low libido, erectile dysfunction, decreased frequency of intercourse, and infertility.  Sexual dysfunction in ESRD is usually multifactorial.  Common contributing factors include vascular/vasoactive impairment, peripheral and autonomic neuropathy, gonadal dysfunction, psychological stress, concurrent medications, and medical comorbidities.

The initial evaluation of sexual dysfunction in patients with ESRD should include a clinical review for possible contributing factors (eg, medications, vascular disease) and limited laboratory testing (eg, serum testosterone, prolactin levels).  Most patients with erectile dysfunction respond to phosphodiesterase inhibitors (eg, sildenafil).  This patient's normal nonsexual morning erections suggest a possible psychogenic component, but this is unlikely to be the only factor in a patient with ESRD, and the effectiveness of psychotherapy for sexual dysfunction in men with ESRD is unknown.

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