The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction

Mulhall, John P.; Giraldi, Annamaria; Hackett, Geoff; Hellstrom, Wayne J.G.; Jannini, Emmanuele A.; Rubio-Aurioles, Eusebio; Trost, Landon; Hassan, Tarek A.

doi:10.1016/j.jsxm.2018.06.005

Cited by 40Sexual function and dysfunction studiesUrological Disorders and TreatmentsSexuality, Behavior, and Technology

The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction

Mulhall, John P., Giraldi, Annamaria, Hackett, Geoff, Hellstrom, Wayne J.G., Jannini, Emmanuele A., Rubio-Aurioles, Eusebio, Trost, Landon, Hassan, Tarek A.·2018·The Journal of Sexual Medicine

DOI 10.1016/j.jsxm.2018.06.005

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Abstract

BACKGROUND: Erectile dysfunction (ED) is a common condition that may affect men of all ages; in 1999, a Process of Care Model was developed to provide clinicians with recommendations regarding the evaluation and management of ED. AIM: To reflect the evolution of the study of ED since 1999, this update to the process of care model presents health care providers with a tool kit to facilitate patient interactions, comprehensive evaluation, and counseling for ED. METHODS: A cross-disciplinary panel of international experts met to propose updates to the 1999 process of care model from a global perspective. The updated model was designed to be evidence-based, data-driven, and accessible to a wide range of health care providers. OUTCOMES: This article summarizes the resulting discussion of the expert meeting and focuses on ED evaluation. The management of ED is discussed in an article by Muhall et al (J Sex Med 2018;15:1280-1292). RESULTS: A comprehensive approach to the evaluation of ED is warranted because ED may involve both psychological and organic components. The updated process of care model for evaluation was divided into core and optional components and now focuses on the combination of first-line pharmacotherapy and counseling in consideration of patient sexual dynamics. CLINICAL IMPLICATIONS: Patient evaluation for ED should encompass a variety of aspects, including medical history, sexual history, physical examination, psychological evaluation, laboratory testing, and possibly adjunctive testing. STRENGTHS & LIMITATIONS: This update draws on author expertise and experience to provide multi-faceted guidance for the evaluation of ED in a modern context. Although a limited number of contributors provided input on the update, these experts represent diverse fields that encounter patients with ED. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. CONCLUSION: Comprehensive evaluation of ED affords health care providers an opportunity to address medical, psychological/psycho-social, and sexual issues associated with ED, with the ultimate goal being effective management and possibly resolution of ED. While some or all techniques described in the updated model may be needed for each patient, evaluation should in all cases be thorough. Mulhall JP, Giraldi A, Hackett G, et al. The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction. J Sex Med 2018;15:1280-1292.

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Medical treatments, especially pharmacotherapy, are often viewed as more effective and cost-efficient than psychological treatments.
“Medical treatments, especially pharmacotherapy, are often viewed as more effective and cost-efficient than psychological treatments because the latter raise uncertainty about treatment duration and outcome.49,87,104,105”
From A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM) (2021) · cites this paper as [87]

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“Based on the initial screening, sexual function could be investigated by focused physical examination and laboratory and instrumental tests aiming to identify the severity of the symptom (subclinical, mild, moderate, severe), to identify the comorbidity with other sexual dysfunctions, to find other comorbid NCDs and r…”
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Ahmed, H. A. S., Abdallah, E. M., Mohamed, M. A. E., Aboelfotoh, T. M., Nour-Eldein, H., & Fouad, A. (2024) · Diabetology International · doi:10.1007/s13340-024-00699-5
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“The current evidence-based international guidelines on the treatment of ED, particularly the EAU Guidelines on Sexual and Reproductive Health 2025 12 and the 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction, 8 as well as the epidemiological data on ED in Arab countries, were reviewed b…”
Advances in Penile Implants and Mechanical Devices for Erectile Dysfunction
Chung, E., Rojas-Cruz, C., & Shah, R. S. (2026) · Springer eBooks · doi:10.1007/978-3-032-29112-7_19

The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction
Mulhall, J. P., Giraldi, A. G. E., Hackett, G. I., Hellstrom, W. J. G., Jannini, E. A., Aurioles, E. R., Trost, L. W., & Hassan, T. A. (2018) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2018.05.021 · Cited by 43 · see citing works
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PD28-01 PROCESS OF CARE OF ED 3.0 FOR THE UROLOGIC PROVIDER
Rosenheck*, M., Sobieski, J., Yang, H., Martin, M., Heidelbaugh, J. J., DiSanto, M. E., & Seftel, A. D. (2020) · The Journal of Urology · doi:10.1097/ju.0000000000000892.01

Authors: Mulhall, J. P., Giraldi, A., Hackett, G., Hellstrom, W. J. G., Jannini, E. A., Rubio-Aurioles, E., Trost, L., & Hassan, T. A.
Affiliations: Memorial Sloan Kettering Cancer Center (US)
University of Copenhagen (DK)
Aston University Birmingham , Birmingham , United Kingdom
Tulane University (US)
University of Rome Tor Vergata (IT)
Asociación Mexicana para la Salud Sexual A.C. (AMSSAC), La Joya , Mexico City , Mexico
Mayo Clinic (US)
Pfizer (United States) (US)
Corresponding author: Mulhall, John P.
ORCID: Mulhall, John P.
Giraldi, Annamaria
Hellstrom, Wayne J.G.
Jannini, Emmanuele A.
Trost, Landon
Venue: The Journal of Sexual Medicine
Publisher: Oxford University Press (OUP)
Published: 2018-07-26
Volume: 15
Issue: 9
Pages: 1280-1292
ISSN: 1743-6095 (ISSN-L)
1743-6109
DOI: 10.1016/j.jsxm.2018.06.005
OpenAlex: W2884841306
Cited by: 40
References: 108
Citations by year: 2026: 2 · 2025: 6 · 2024: 3 · 2023: 7 · 2022: 5 · 2021: 8 · 2020: 3 · 2019: 6
FWCI: 3.32
Type: journal article
Language: en
Open access: closed
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Journal of Sexual Medicine (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders: Pfizer Inc. Editorial
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Health Sciences › Medicine › Urology › Urological Disorders and Treatments
Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
Keywords: erectile dysfunction, psychological assessment, sexual counseling, first-line pharmacotherapy, sexual history, laboratory testing
MeSH terms: Humans, Erectile Dysfunction, Male, Models, Theoretical

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The 2018 Revision to the Process of Care Model for Evaluation of Erectile Dysfunction

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