A 54-Year-Old Man Is Evaluated for Erectile Dysfunction

A 54-year-old man is evaluated for erectile dysfunction.  The patient has been having problems attaining and maintaining erections during sexual activity for the past 6 months.  Prior to the development of this problem, he had an active and satisfactory sex life.  The patient continues to have normal early-morning penile erections.  Medical history is notable for hypertension, mixed hyperlipidemia, gastroesophageal reflux, and lumbar stenosis with a chronic right L4 radiculopathy.  His current medications include ibuprofen, ranitidine, lisinopril, and atorvastatin.  The patient smokes a pack of cigarettes daily and drinks alcohol only on social occasions.  Blood pressure is 144/78 mm Hg and pulse is 80/min.  BMI is 35 kg/m².  Physical examination shows normal body hair distribution and testicular size with no gynecomastia.  Which of the following is the most likely cause of this patient's erectile dysfunction?

A) Adverse effect of medication
B) Atherosclerotic vascular disease
C) Decreased testosterone production
D) Hyperprolactinemia
E) Lumbar radiculopathy
F) Psychosocial factors

Correct Answer:

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