1.What is erectile dysfunction? Erectile dysfunction (ED), commonly known as “impotence”, is the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse for more than 6 months. The Chinese Medical Association’s Men’s Branch of the “Guidelines for the Treatment of Male Diseases” defines ED as the persistent inability of the penis to achieve and maintain an erection sufficient for satisfactory sexual intercourse over the past three months. The necessary conditions for an erection are sufficient sexual stimulation, adequate arterial blood supply, normal penile white membranes and proper venous leakage of blood. The brain receives signals of sexual stimulation, and then the nerves, blood vessels and androgens act in concert to fill the penile corpus cavernosum with blood to achieve a new balance of blood in and out. 3, what are the common causes of erectile dysfunction? At present, it is generally believed that the onset of ED is multi-factorial, according to the different causes can be divided into three categories: psychogenic, organic and mixed. ED is often a sign of cardiovascular disease, diabetes, hyperlipidemia, metabolic syndrome and other related diseases, and some data show that ED occurs about 5-6 years earlier than the appearance of cardiovascular disease symptoms. Therefore, middle-aged and elderly patients suffering from ED should be careful to prevent cardiovascular accidents. 4, how to determine the severity of ED? The current internationally accepted method of evaluating ED is the integral method, which determines whether further examination and treatment is required by the sum of the points. Usually the duration of the disease should be ≥ 6 months to diagnose ED, the diagnosis of trauma or surgery-induced ED can be shorter than 6 months. The total score corresponds to the disease: 5-7 for severe ED, 8-11 for moderate ED, 12-21 for mild ED, and 22-25 for normal values. The total score ≤ 21 points, it is necessary to further examine to determine whether the ED. specific measurement charts see the International Index of Erectile Function 5-item questionnaire (IIEF-5). 5, ED how to treat? (1) For those who visit the clinic for unsatisfactory sexual life or erectile function, determine the severity of ED, assess the etiology and risk factors, if there is an obvious cause or etiology, the following conventional treatment measures can be given on the basis of active treatment of the primary cause: ① General management and psychotherapy, including patient and sexual partner education; improvement of lifestyle, such as quitting smoking and reducing alcohol consumption; treatment of psychological factors. Discontinuation of medications that cause ED. ②Etiological treatment drugs, including good control of blood glucose levels in diabetic patients, blood pressure levels in hypertensive patients, correction of risk factors such as dyslipidemia; active treatment of psychiatric disorders such as depression; treatment of endocrine disorders such as hypermetrolactinemia; treatment of hypogonadism and insufficient androgen secretion; androgen replacement therapy for patients with reduced serum testosterone. (③If there is no improvement in the above treatment for 3 months, evaluate patients with combined cardiovascular disease, if it is unsafe to resume sexual life, treatment and control of cardiovascular disease is preferred; if it is safe to resume sexual life, specific treatment of ED can be performed. (2) Specific treatment: ① First-line treatment: non-pharmacological treatment can be used as an adjunctive treatment measure, receiving counseling and counselling from specialists in sexual/marital problems. Pharmacological treatment mainly refers to occasional on-demand, or regular on-demand (every other day) phosphodiesterase inhibitors, or tadalafil in small daily doses; the backup drug is apomorphine (sublingual); patients with low blood androgen levels may be treated with testosterone preparations in combination with the above drugs for replacement. If the efficacy of first-line treatment is satisfactory, continue the original effective treatment and follow up every 6 months to further relieve patients’ concerns or detect other psychological and physical dysfunctions, observe the efficacy and adverse effects, adjust the drug dose or change the treatment method as needed, and adjust the medication for the treatment of combined diseases. If the efficacy of the first-line treatment is not assessed satisfactorily, second-line treatment is used. ③Second-line treatment: intracavernosal injection and vacuum negative pressure erection device. The vacuum negative pressure erection device is convenient, simple and effective. ④If the second-line treatment fails and further treatment is required, male specialists and urologists will be consulted to guide the adjustment of treatment and switch to third-line treatment as needed, including penile prosthesis implantation and penile vascular surgery. Among them, penile prosthesis implantation has a definite effect.