A 50-year-old man reports sudden onset of ED about 6 months previously. He has been married to his wife for 25 years and reports that their relationship is very good. However, lately, he is less interested in sex with his wife and feels guilty because he sometimes dreams of having sex with other women, which produces firm nocturnal erections. His medical history is remarkable for diabetes, hypertension, and hyperlipidemia, which have all been stable for the past 3 years while he was receiving medical therapy with metformin, hydrochlorothiazide, and atorvastatin.
Physical examination The patient is obese and has a normal effect, and has a blood pressure of 130/80 mm Hg. Findings on examination are otherwise unremarkable. Laboratory testing yields normal results for complete blood cell count and for levels of electrolytes, creatinine, and glycated hemoglobin. What can be the most likely…
