This initial release of nitric oxide is mediated in part by testosterone. As the corpus cavernosum fills with blood, the veins that drain the corpus cavernosum are compressed, resulting in maintained turgidity. Erections are initiated when nitric oxide and other neuroendocrine factors induce relaxation of the smooth muscles of the cavernous arteries and tissues resulting in increased penile blood inflow. Д®rection requires a combination of vascular, neurologic, psychologic, and hormonal factors. The minimal clinically important differences (MCID) for moderate and severe ED are a change of 5 and 7 IIEF-EF points, respectively. The IIEF-EF is often used in studies to trend changes in erectile function, with a change of 2 IIEF-EF points being clinically significant for men with mild ED. The severity of ED is then classified as mild, mild to moderate, moderate, and severe dysfunction.

The IIEF-EF consists of 6 questions that inquire about frequency and hardness of erections, ability to penetrate during intercourse, ability to maintain an erection during intercourse, ability to maintain an erection to completion of intercourse, and confidence in a manвЂ™s ability to get and maintain an erection. Subjective erectile function can be assessed using validated questionnaire metrics including the international index of erectile function (IIEF) with the erectile function domain (IIEF-EF) being the most specific for assessing ED. The National Institute of Health (NIH) defines ED as the вЂњinability to achieve or maintain an erection that is satisfactory for sexual performanceвЂќ. Testosterone Therapy Improves Symptoms of Mild Erectile DysfunctionД®D affects 1 in 5 men, with this frequency increasing with age and the prevalence of co-morbidities.

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