Recently on the online platform often encountered many friends asked “recently I feel I am impotent, how to do when my husband is impotent?” I think we should follow this online platform to popularize. I, the incidence of erectile dysfunction Recent epidemiological data show that the incidence of ED is high worldwide. The Massachusetts Male Aging Study (MMAS) conducted the world’s first large-scale population susceptibility study. The results showed an overall prevalence of ED of 52% in men aged 40 to 70 years in the Boston area. In this study, the prevalence of mild, moderate, and severe ED was 17.2%, 25.2%, and 9.6%, respectively. The causative factors can make lack of exercise, obesity, smoking, hypercholesterolemia and metabolic syndrome, etc. Second, the risk of sexual life on cardiovascular disease The high incidence of cardiovascular disease in patients with sexual dysfunction has been well established the close relationship between cardiovascular risk factors and sexual activity. Moreover, recent epidemiological studies show that regardless of men and women, cardiovascular and metabolic disorders have a greater relationship with sexual dysfunction. The risk of sexual life for cardiovascular disease can be classified as low, moderate or high. These risk factors are the basis for determining the initiation of treatment and resumption of sexual activity. And from the condition to determine the amount of exercise tolerance, thus predicting the risk of sexual life. The pathophysiological mechanisms of ED include vascular, neurological, endocrine, anatomical, pharmacological, and psychiatric aspects. The information gathered reveals many common conditions associated with ED, such as: vascular, anatomical or physiological, neurological, hormonal, pharmacogenic, and psychiatric disorders. To make communication about ED and other sexual problems easier, history taking should be done in a relaxed environment, especially important when certain patients are reluctant to volunteer to describe their problems. This atmosphere makes it easier to communicate between the doctor and patient and makes it easier for the doctor to develop a treatment response. Second, special examination (a) the indications for special examination of ED 1, major erectile disorders (non-organic or psychogenic lesions); 2, young patients with a history of pelvic or perineal trauma may be cured by vascular surgery; 3, penile deformities requiring surgical correction (e.g., sclerosis, congenital curvature); 4, with complex psychiatric or psychosexual disorders; 5, with complex endocrinopathies; 6. Special examination requested by the patient or partner; 7. Forensic requirements (e.g., penile pacemaker or sexual abuse, etc.). (II) Special tests are 1. nocturnal penile swelling and hardness test using a comprehensive diagnostic instrument for penile erectile function; 2. vascular examination intra-cavernous sinus vasoactive drug injection; cavernosal ultrasonography; penile cavernosography; pubic arteriography. 3.Neurological examination (such as ball cavernous muscle reflex latency, nerve conduction study); 4.Endocrinological examination; 5.Psychological examination. (C) ED after prostate eradication Studies have found that approximately 25-75% of men suffer from ED after prostate eradication [2], and the reasons for this are multiple, but one thing is certain, to ensure that the penis can still be erected after surgery, the cavernous vascular nerves must be protected during surgery. In addition, penile vascular insufficiency will increase the chance of suffering from ED after surgery. Fourth, the treatment of erectile dysfunction a. Establish the primary goal of ED treatment is to remove the cause of certain ED patients can improve symptoms but not cure. Most patients need to receive non-causal treatment, in order to better counsel patients, doctors need to have as much information as possible about various therapies. The choice of treatment should focus on effectiveness, safety and satisfaction of the patient and his or her partner, as well as other quality of life factors. Second, correcting poor lifestyle and underlying disease treatment First recognize which ED triggers exist for the patient, and lifestyle changes should be made before or at the same time as treating ED. Lifestyle changes have significant relevance to patients with ED. Especially with cardiovascular disease or metabolic diseases such as diabetes and hypertension. The results of recent studies prove that: patients actively changing bad habits are beneficial not only for erectile function, but also for the whole body. The actual PDE5 inhibitors have been introduced to revolutionize the treatment of post-operative ED. These drugs are efficacious, easy to take, well tolerated and safe, and can improve the quality of sexual life of patients. At present, PDE5 inhibitors are the first choice of oral treatment drugs for the treatment of postoperative ED patients (cavernous nerve preservation). Fourth, emphasize that three kinds of ED can be cured Some patients can be cured, for example: psychogenic ED, ED in young patients after vascular trauma, and ED caused by hormonal reasons (such as gonadal insufficiency, hyperprolactinemia, etc.). V. Third-line treatment (a) first-line oral drugs Mainly PDE5 inhibitors are tadalafil (tadalafil), vardenafil (vardenafil), sildenafil (sildenafil), etc.; these drugs do not automatically trigger an erection, and require sexual stimulation to be effective. 1, the choice between PDE5 inhibitors To date, there are no multicenter double-blind or triple-blind studies comparing three drugs. Patients should be made aware of the effects (short- or long-acting) and possible side effects of the various drugs. The frequency of sexual intercourse of the patient and the personal experience of the doctor should be used to decide which drug to use. 2, PED5 inhibitors ineffective causes and countermeasures The two most important reasons are incorrect use of the drug or the drug does not work. The following potential causes need to be identified: check that the drug the patient is taking is regular, because there is a large number of fake brand PED5 inhibitors in the black market; check whether the drug is taken correctly. The main ones are: lack of sufficient sexual stimulation; drugs are not taken in sufficient amounts; waiting time between taking drugs and having sex is too long; diet affects the absorption of drugs. 3, other drugs Apomorphine sublingual administration requires 2 to 3 mg. this drug has been applied in many countries except the United States. Apomorphine has no significant effect on improving libido, but it should be noted that this drug has a slight effect on improving orgasm. Other drugs include: yohimbine, dilaquimin, trazodone, left type arginine, kojic acid, limaprost, phentolamine, etc. (B) Topical administration Topical application of several vasoactive agents (2 % nitroglycerin, 15-20 % poppies, 2 % minoxidil solution or gel) to the penis. In order to overcome the problem of dense tissue of the white membrane that makes the drug difficult to absorb, several drugs that improve absorption are used in combination with vasoactive agents. Topical treatment has not been widely accepted and its place in the treatment of ED is currently unknown. (iii) Vacuum compression device (VCD) The vacuum compression device causes passive engorgement and swelling of the corpus cavernosum, followed by a constriction ring that is placed over the root of the penis to block blood in the corpus cavernosum. This device is therefore not used to maintain an erection through the physiologically normal route. In terms of erectile satisfaction, the efficiency is as high as 90%. Regardless of the cause of ED, satisfaction rates range from 27% to 94%. Patients experience common adverse effects, including pain, weakness of ejaculation, bruising, abrasions, or numbness. Serious adverse effects (skin necrosis) can be avoided if the patient can remove the constriction ring within 30 min. Contraindications are patients with bleeding disorders or those on anticoagulation therapy. (iv) Second-line treatment 1. Intracavernosal penile injection ( ICI) If the patient does not respond to oral medication, intracavernosal penile injection can be recommended, which is highly effective. Complications include penile pain (50% of patients present at the time of injection and 11% after injection), persistent erection (5%), abnormal penile erection (1%) and fibrous degeneration (2%) [6]. The addition of sodium bicarbonate or local anesthetic may reduce pain, and the development of fibrous degeneration requires stopping the injection for several months. Systemic side effects are uncommon, the most common being mild hypotension after high dose use. 2. Therapeutic measures for sustained erection If erection exceeds 4h, the patient should be advised to seek medical attention to avoid tissue damage in the cavernous sinus, as it may lead to permanent impotence. Blood is aspirated using a 19-gauge needle to reduce the intracavernous sinus pressure. This simple method of weakening the penis is usually effective. If the penis hardens again, phenylephrine is injected at a starting dose of 200 μg, which can be increased to 500 μg every 5 min. The risk of the next sustained erection is unpredictable and usually the next dose is reduced. 3. Combination therapy The purpose of combination therapy is to take advantage of the advantages of various therapies to reduce side effects and reduce the dose of individual drugs. Mixed preparations such as poppyine (7.5 to 45 mg) plus phentolamine (0.25 to 1.5 mg), or poppyine (8 to 16 mg), phentolamine (0.2 to 0.4 mg) plus prostaglandin E1 (10 to 20 μg), the above preparations have been widely used and highly effective (especially the latter). The efficiency of the combination of opium poppy, phentolamine, and prostaglandin E1 reached 92%, and the complications were similar to those that occurred with prostaglandin E1 alone. 4, intraurethral use of prostaglandin E1 a small mass containing prostaglandin E1 (MUSETM) has been approved for the treatment of ED. due to the vascular interaction of the urethra and corpus cavernosum, allowing the drug to be transported in these tissues. In clinical practice, only high dose (500 and 1000 μg) groups are in use and results are inconsistent. The use of constriction rings at the root of the penis improves the results. The efficacy is significantly lower than that of cavernous injection therapy. Intraurethral administration is a second-line therapy, offered as an alternative to cavernous injection for patients who prefer less invasive options, but with poorer efficacy. V. Third-line therapy-penile pacemaker The penile pacemaker, also known as a penile prosthesis, is indicated for patients who have failed medication or who want a permanent solution. It has a high satisfaction rate and it is an attractive option for those who do not want to take oral drug therapy. Based on proper consultation, prosthetic implantation has one of the highest satisfaction rates for the treatment of ED. V. Erectile Dysfunction Conclusion Drug therapy for ED has made tremendous progress. The three PDE5 inhibitors (sildenafil, tadalafil, and vardenafil) are revolutionary breakthroughs in the contemporary treatment of ED. Such drugs are highly effective and safe, even in refractory ED (e.g., diabetic, post-radical prostatectomy ED). Patients should be encouraged to experience all three PDE5 inhibitors and then decide which drug to use, taking into account differences in onset of action, duration and side effects. Penile cavernosal injections, intraurethral administration, vacuum contraction devices, and penile prostheses are options for patients for whom oral medications are ineffective or contraindicated.