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Our understanding of, and attitude toward, male sexual health, and in particular, erectile function and dysfunction, is dynamic and has been continuously evolving. As recently as 25 years ago, this field was considered to be the exclusive domain of psychologists and/or endocrinologists. The advent of penile prosthesis insertion in 1973 and other, non-surgical, therapies such as vacuum constriction devices and local self-injection of agents in the 1980s brought the urologist to the forefront of clinical practice. This speciality has contributed greatly to current understanding of the physiology of the erectile process, the pathophysiology of erectile dysfunction (ED) and diagnostic and therapeutic options in patient management. Not surprisingly, from the therapeutic perspective alone, there has been, and continues to be, considerable improvement in the availability of user-friendly, reliable, and dependable interventions in the area of male sexual health.

Penile erection is the most obvious feature of the male body’s response to sexual excitement. It is a complex neurovascular response, influenced by cognitive inputs and facilitated by testosterone [12]. Other features of that response include increases in skin temperature, blood pressure, heart and breathing rates, facial and bodily flushing, dilation of the pupils, and nipple erection. There are also changes in skin’s sensitivity to touch. These changes are similar in both men and women.

ED is frequently described by its presumed etiology; for example, ‘vasculogenic’, ‘diabetogenic’, and ‘psychogenic’. These descriptions can be very misleading and it is better always to think of ED as a health problem with multifactorial etiology. This is illustrated in the following two examples.

The purpose of clinical assessment is to identify and agree the nature of the individual’s/couple’s problem(s), why it has occurred, their aims for treatment outcome, and whether this may realistically be achieved with biomedical or pysychotherapeutic interventions. These are summarized in Figure 12.

The treatment plan should always include the following components.

Basic sex education: This is the vital first step in effective treatment, leading to a successful outcome, in which the individual or couple can enjoy ‘a satisfactory sexual experience’, rather than just get erections. Do not underestimate its importance and do not omit it.

• Approved intracavernosal injection therapy • Transurethral therapy Most physicians with an interest in sexual medicine and ED will offer transurethral or intracavernosal therapy. The techniques for preparing and administering such treatments are fairly straightforward but it is much more challenging to actually teach another person how to do it. If you are interested in offering these treatments, it would be sensible to spend some time with a health professional experienced in teaching patients these techniques, as you will have to develop teaching as well as clinical skills.

Sex is a central part of the human experience and to deny this is to deny our humanity. Whilst some people make a choice to remain celibate and clearly enjoy wholly fulfilling lives, for the vast majority sex remains important to them throughout their adult lives.