I. Basic treatment (a) Correction of risk factors: such as smoking, alcoholism, hyperlipidemia, obesity, drug abuse, etc. (2) Strengthen the treatment of primary diseases: such as diabetes, hypertension, penile sclerosis, endocrine system diseases, etc. (C) adjust the psychological state: lift anxiety, tension, depression, etc. (D) strengthen sexual medicine education. (E) Harmonize the relationship between husband and wife: spouse participation and spouse encouragement. Second, the first line of treatment (oral drug therapy) The advantages of oral drugs are: easy to use, safe, effective, easily accepted by most patients, currently as the first line of treatment for ED. (A) selective phosphodiesterase type 5 inhibitor (PDE5) Because PDE5i has a mild dilating effect on peripheral blood vessels, it is contraindicated for those taking nitrates; the use of PDE5i is restricted for ED patients with cardiovascular risk factors. 1, sildenafil (sildenafil, trade name: Viagra) Sildenafil doses of 25, 50 and 100 mg, respectively The recommended clinical starting dose is 50mg, and the dose is adjusted according to the therapeutic effect and adverse effects. Sildenafil 25, 50 and 100 mg were effective at 56%, 77% and 84%, respectively, and sildenafil improved erectile function by 66.6% and sexual intercourse by 63% in diabetic patients, compared to 28.6% and 33% in the placebo control group, respectively. In patients undergoing radical prostatectomy with nerve preservation on both sides, 76% of patients were able to have successful vaginal penetration after taking the drug. 2. vardenafil (trade name: Elidel) The structure of vardenafil differs slightly from that of sildenafil, with an enhanced inhibition of PDE5i activity. The overall clinical efficacy is similar to that of sildenafil, but the onset of action is faster than that of sildenafil, with oral vardenafil taking effect within 30 min of sexual stimulation; the efficacy rates of vardenafil 5, 10 and 20 mg are 66%, 76% and 80%, respectively. The results of clinical studies showed that vardenafil significantly improved the International Index of Erectile Function (IIEF), Sexual Life Diary (SEP)2 and 3, General Assessment Question (GAQ) and satisfaction scores; the clinically recommended starting dose of vardenafil is 10 mg, and the dose should be adjusted according to efficacy and adverse effects. Vardenafil improved erectile function in 72% of diabetic patients; in patients undergoing radical prostatectomy with bilateral nerve preservation, the success rate of intercourse was 74% and 28% in patients with mild to moderate ED and severe ED, respectively, after taking vardenafil 20 mg. 3, tadalafil (tadalafil, trade name: cialis) The structure of tadalafil is significantly different from sildenafil and vardenafil, with a relatively long half-life (17.5h). Tadalafil starts to take effect 30min after taking the drug and reaches its optimal effect about 2h. Diet has little effect on the drug effect. Patients taking tadalafil 10 and 20 mg had clinical effectiveness rates of 67% and 81%, respectively; statistics showed that tadalafil significantly improved patients’ IIEF, SEP2, SEP3, GAQ and satisfaction scores. Oral doses of tadalafil are 10 and 20 mg. The recommended starting dose is 10 mg, and the dose should be adjusted according to efficacy and adverse effects. Tadalafil improved erectile function in 64% of patients with diabetic ED; in patients undergoing bilateral nerve-preserving radical prostatectomy, the rates of achieving adequate erectile hardness for insertion and successful intercourse were 54% and 41%, respectively. In order to avoid complications such as hypotension, patients taking alpha-blockers should refer to the instructions for use of the above three drugs or follow medical advice when applying them. (ii) Apomorphine hydrochloride tablets Apomorphine (Uprima and Ixense) is a dopamine agonist in the central nervous system. Apomorphine is effective in patients with mild to moderate ED and ED caused by psychiatric factors. (iii) Testosterone supplementation therapy Patients with ED with low testosterone levels have some effect with androgen supplementation or in combination with PDE5i, if other endocrine testicular decline is excluded. However, androgen supplementation therapy is contraindicated in patients with prostate cancer or suspected prostate cancer. Therefore, rectal prostate examination (DRE) and PSA measurement, as well as liver function tests, should be routinely performed before androgen supplementation. Patients receiving testosterone supplementation therapy should undergo regular liver function and prostate cancer index tests. (IV) Chinese medicine preparations There are many kinds of Chinese medicine preparations for the treatment of ED in the domestic market, but these drugs are difficult to verify their mechanism of action by modern medical experimental methods due to the complexity of the components they contain, clinical application can refer to the relevant regulations of the national administration of Chinese medicine, and continue to summarize and standardize the use of drugs according to the principles of evidence-based medicine. Third, the second line of treatment methods (a) vacuum negative pressure erection device and narrowing ring Vacuum negative pressure erection device and narrowing ring are suitable for patients who do not want to use drug therapy and contraindication to drug therapy, usually with a clinical efficiency of about 60%. Common adverse effects include pain, decreased penile skin temperature. Penile pain, ejaculation pain, numbness of erection, and subcutaneous bruising and bruising. Contraindications include patients with bleeding disorders or those on anticoagulation therapy. (ii) Intracavernosal drug injection therapy is also an option when first-line therapy is ineffective or has significant adverse effects. Prostaglandin E1 (Caverject, Kaiser, etc.) is the commonly used drug, and the dose used is 5-20 mg. The safest and effective dose needs to be selected. The vasoactive drug is injected into the cavernous body of the penis using a skin test syringe and usually induces an erection in 5 to 10 min. Poppyrine (7.5 to 45 mg) and phentolamine (0.2 to 0.5 mg) can also be used in penile cavernosal injection therapy for ED, with an overall clinical effectiveness of about 70%. The possible adverse effects of penile cavernous drug injection therapy include dizziness, pain, subcutaneous bruising, cavernous fibrosis, and serious complications such as abnormal ischemic penile erection. Therefore, it is necessary to choose the safest effective dose with the informed consent of the patient, adjusted by a specialist physician, and carefully instruct the patient on the method of use and the dose to be used. Fourth, the third line of treatment methods (a) penile prosthesis implantation penile prosthesis has a single set of flexible erectile device and two sets, three sets of the expansion erectile device, through surgery in the penile corpus cavernosum implant penile erectile device, assist penile erection to complete sexual intercourse, is a semi-permanent treatment method. The surgery is suitable for patients with severe organic ED who have not been treated by various methods, patients who are in good general condition, no perineal, external genital and systemic acute and chronic infections, and patients with a stable mental and psychological state who voluntarily request surgical treatment. Penile prosthesis implantation surgery for ED generally does not affect penile sensation, urination and ejaculatory function. Common surgical complications include infection, erosion, side injuries and long-term mechanical failure. The penile prosthesis can effectively reduce the infection rate by applying an antibiotic film to its surface. The incidence of mechanical failure of the penile prosthesis in patients with penile prosthesis implantation surgery is about 10% within 10 years and requires reoperation for replacement, so the decision to treat the prosthesis surgically must be made after informed consent of the patient. (B) vascular surgery including penile artery reconstruction and penile vein ligation surgery, for patients with a clear diagnosis of arterial or venous ED through a detailed special examination, the long-term results of vascular surgery for ED need to be further improved. V. Treatment of ED patients with cardiovascular risk factors ED is not life-threatening, but it can significantly affect the quality of life, and a significant proportion of ED patients with combined cardiovascular disease. Because sexual activity is an excitatory physical activity, some cardiovascular patients in the treatment of ED, should be carefully assessed in advance by cardiovascular experts in detail, the overall cardiovascular function of the patient before deciding whether the patient should be ED-related treatment. Six, review and follow-up Each ED patient receiving ED treatment should be regularly reviewed and followed up. (a) doctor-patient communication, to further relieve the patient’s concerns or detect other psychological and physical dysfunction. (2) Observation of drug efficacy and adverse reactions, adjustment of drug dose or change of treatment method. (c) Adjustment of medication for combined diseases.