General: depression, performance anxiety, nonadherence to meds. Inability to have sex, which may or man not be associated with decreased libido & ejaculatory disorders. Iief survey that show low satisfaction & quality. Assessment: conduct iief-ef, a self-assessment to asses severity of ed, conduct assessment of cardiac reserve based on medical history, s&s, cv disease, threadmill testing. If signs of hypogonadism & decreased libido, a serum testosterone may be below range. If patient has enlarged prostate based on digital rectal exam, a blood test for prostate specific antigen should be run. If elevated, patient may have prostate disroder, which can contribute to ed. Improve quality & quantity of penile erections & considered satisfactory by patient. & partner: objective measure of improvement includes an increase in 4-point in iief-ef scores or achieve a total score of 20. General approach to treatment: third princeton consensus conference is approach to manage ed.