Male Sexual Disorders: Penile Disorders

Erectile dysfunction can result from organic, psychogenic, or substance-induced causes. Phosphodiesterase type 5 inhibitors are the mainstay of medical treatment, although other medications and interventions, such as intracavernosal injection therapy and constriction devices, can also be used. Priapism is defined as a prolonged erection of the penis continuing after or irrespective of sexual stimulation. It may result from conditions causing ischemic states or dysregulation of arterial inflow. Acute ischemic priapism is a medical emergency and can result in irreversible erectile dysfunction. Nonischemic priapism is not an emergent condition and should resolve spontaneously. Phimosis, or inability to fully retract the penile prepuce over the glans, is a congenital or acquired condition and can cause discomfort. Physiologic phimosis usually resolves by age 16 years, whereas pathologic phimosis may require circumcision for definitive treatment. Paraphimosis, an emergent condition, results from the foreskin becoming trapped proximal to the coronal sulcus. Treatment consists of manual reduction. In Peyronie disease, fibrous plaques develop in the penile shaft, subsequently causing deformity of the penis when erect. Surgical and nonsurgical treatment options, such as collagenase or intralesional injections, are available.