2 Indications and current treatments
2.1 There are many causes of erectile dysfunction (ED). It is often multifactorial and precise identification of a cause may be complex. One cause of arteriogenic ED is atherosclerosis causing narrowing or blocking of the arteries in the pelvis or the penis and reducing blood flow to the penis. This guidance is limited to treatment of atherosclerosis in arteries distal to the internal iliacs. It does not include angioplasty or stenting of the iliac arteries done for intermittent claudication, with ED as an accompanying symptom.
2.2 Treatment of ED secondary to atherosclerosis includes management of cardiovascular risk factors (stopping smoking, antithrombotic medication and statin treatment) and oral phosphodiesterase‑5 inhibitors. In ED that has not responded to conservative treatments or phosphodiesterase‑5 inhibitors, other options (including vacuum erection devices, intracavernosal or intraurethral prostaglandin, and penile prostheses) or surgical revascularisation may be considered.