Impotence, also known as erectile dysfunction (internationally referred to as ED), refers to the inability of the penis to get an erection or a weak erection when sexually desired, or the inability to maintain sexual intercourse for a sufficient amount of time despite having an erection and a certain degree of hardness, thus preventing sexual intercourse or the inability to complete it. The incidence of erectile dysfunction accounts for about 50% of adult men. Male sexual dysfunction includes hypoactive sexual desire, erectile dysfunction, orgasmic and ejaculatory dysfunction, penile weakness dysfunction, of which erectile dysfunction is the most common male sexual dysfunction. I. Disease etiology Male erection is a complex process involving the brain, hormones, emotions, nerves, muscles and blood vessels and other aspects. Erectile dysfunction may be related to 1 or more of these causes. Second, classification Erectile dysfunction can be classified as psychological erectile dysfunction and organic erectile dysfunction according to the cause. Organic erectile dysfunction accounts for 50%, mainly including vascular, neurological, endocrine, diabetic, penile cavernous fibrosis, etc. Erectile dysfunction can be divided into mild, moderate and severe according to the degree of severity, of which severe erectile dysfunction refers to long-term persistent most of the time can not complete a satisfactory sexual life. Because sexual life involves both husband and wife, the judgment of the patient’s sexual function patiently listen to the narrative of both husband and wife. The main contents should include: 1, the cause of erectile dysfunction, the length and severity of the disease; 2, whether erection can be achieved at night, morning awakening, masturbation and visual stimulation; 3, whether changes in sexual position have an effect on erectile hardness; 4, changes in libido and ejaculation; 5, social and family psychological trauma; 6, whether there are chronic diseases, medications and surgical trauma; 7, the history of sexual dysfunction, the history of drug use and surgical trauma; 8, the history of sexual dysfunction, the history of sexual dysfunction, the history of sexual dysfunction, the history of sexual dysfunction, the history of sexual dysfunction. 6. history of chronic diseases, drug use and surgical trauma; 7. history of smoking, alcoholism and drug abuse. Each patient should undergo a comprehensive systemic examination, focusing on the development of the reproductive system, secondary sexual characteristics and cardiovascular and neurological examinations. Abnormalities in the development of the reproductive system and secondary sexual characteristics often suggest primary or secondary hypogonadism and endocrine erectile dysfunction due to pituitary lesions. The dorsalis pedis artery is not palpable or the bulbocavernosus reflex disappears, and the perineal sensation is dull indicating the possibility of vascular or neurogenic erectile dysfunction. V. Laboratory tests Focus on testing for heart disease, diabetes mellitus, low testosterone levels and other related diseases. Psycho-psychological test The Multiple Personality Inventory (MMPI), Derogatis Sexual Function Inventory, California Personality Inventory, etc. are of reference value for identifying psychological and organic erectile dysfunction, but cannot be used as an important basis. Ultrasonic testing Mainly detects the structure and blood flow of the penile cavernous body, and if necessary, the cavernous body is injected with vasodilator drugs to observe the change of blood flow rate. Nocturnal penile erection monitoring This test is less affected by psychological factors and can respond more objectively to the erectile function of the penis. In normal people, the erection of the penis is 3-5 times per night and lasts for 25-40 minutes in the state of rapid-motion sleep. The sensitivity of monitoring the change of erectile hardness at night by penile erectile hardness meter (rigiscan) reaches 70%. 9. Penile cavernosal perfusion test and penile cavernosography (dynamic infusion cavernosometry &cavernosography, DICC), which usually monitors the induction flow (IF), the maintenance flow (MF), and the cessation of erection. Larger values of MF and PL indicate the presence of venous leaky erectile dysfunction. Normal PL should be <3.3kPa (25mmHg) within 30 seconds, MF should be <20-40ml/min, and IF should be 80-120ml/min. Penile cavernosography is the observation of abnormal venous return during erection by injecting contrast medium. The common abnormalities are: deep dorsal penile vein to prostatic plexus and intrapubic vein, penile cavernous vein to prostatic plexus and intrapubic vein, penile cavernous body to urethral cavernous body leak. Selective penile artery angiography For suspected penile artery supply disorders, bilateral internal pubic artery angiograms should be performed via the femoral artery to observe the lesions of the dorsal penile artery and cavernous artery on both sides before performing penile artery reconstruction. Nerves play an important role in the erection mechanism, so routine testing of the erection-related nervous system is crucial in the etiological diagnosis, especially in patients with a history of cranio-cerebral, spinal cord, pelvic trauma and diabetes mellitus. Twelve, treatment: 1, general treatment to change the poor lifestyle, prevention and control of high-risk factors, such as increased exercise, weight loss and drugs that can cause ED, active treatment of diabetes, hypertension of the original law of the disease. Such as testosterone secretion deficiency caused by primary testicular disease or secondary to pituitary, hypothalamic disease, as well as middle-aged and elderly late gonadal dysfunction can take testosterone supplementation therapy 2, psychotherapy For patients with obvious psychosomatic diseases, psychosexual treatment can be carried out alone or with other treatment modalities. However, psychosexual treatment takes time and its efficacy is uncertain.