Disorders of male sexual function may affect libido, erection, ejaculation or orgasm. Sexual dysfunction can have psychological as well as organic causes. Risk factors include increasing age, diabetes, high blood pressure, cardiovascular disease, medication side effects, smoking, alcohol consumption, endocrine disorders such as testosterone deficiency, anxiety or depression, neurological conditions including injury or tumour, vascular disease, developmental abnormalities such as micropenis and penile deformities.
After a detailed medical history and physical examination, further assessment may include a vasoactive injection test to induce an erection and specialist colour-duplex Doppler ultrasound to evaluate penile blood flow. Once the cause has been clarified, treatment options may include oral medication, hormone therapy, medication administered through the urethra, self-injection therapy into the penis, psychotherapy, vacuum devices and surgical solutions, including ligation of abnormal vessels or implantation of a penile prosthesis.
Penile prosthesis implantation may be indicated in severe erectile dysfunction or impotence that has not responded adequately to other treatments, in Peyronie’s disease accompanied by severe erectile dysfunction, or after surgical construction of a penis. Available devices include flexible or semi-rigid prostheses and modern inflatable hydraulic prostheses, which generally provide the most natural functional result. Inflatable systems can reproduce both a flaccid state and an erection. Despite widespread misinformation, modern prostheses can provide a natural appearance and reliable rigidity in most appropriately selected cases. At the time of implantation, selected techniques may also allow limited lengthening or girth enhancement, for example with grafting or fillers. Individual planning and a thorough examination are required before every penile prosthesis operation.