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Erectile dysfunction (ED) is defined as the persistent inability to attain or maintain penile erection sufficient for satisfactory sexual performance. Despite its benign nature, ED may affect the physical and psychosocial well-being of sufferers, causing a significant impact on their quality of life (QoL). Recent evidence has pondered ED as an early manifestation of cardiovascular disease suggesting that its occurrence should not be dealt with as only a QoL issue, but also as a potential warning sign of a more serious medical condition. With an increasing knowledge about possible disturbances of penile erection, new organically oriented therapeutic options have been developed, which have revolutionized the treatment of ED. Through the use of clinical scenarios, this chapter reviews the available approaches for the evaluation and management of patients presenting with ED.

Azoospermia is defined as absence of spermatozoa in the ejaculate. It is found in around 15% of men presenting with infertility. The introduction of intracytoplasmic sperm injection in the early 1990s was coupled with major advances in surgical sperm retrieval. This dramatically changed the concept in management of azoospermia patients, giving them the hope of having their biological child. The current chapter will discuss the management of these cases according to the best medical practice.

Obesity has become a major health concern, with a prevalence rate approaching epidemic states. An inverse relationship between men's body weight and semen parameters has been observed, suggesting a favourable role for weight loss in improving fertility. This prospective study included 46 patients undergoing sleeve gastrectomy, who were investigated with semen analysis and serum hormone tests before and 12 months after surgery. Patients were divided into three groups according to their initial sperm concentration; median loss of body mass index was used as a cut-off to further classify patients according to extent of weight loss. Patients' preoperative seminal investigations revealed azoospermia in 13 (28.3%), oligospermia in 19 (41.3%) and normal sperm concentration in 14 (30.4%). Overall, only serum testosterone significantly increased after surgery (P0.001). Between study groups, the increase in sperm concentration was statistically significant in men with azoospermia and oligospermia (both P0.05), whereas serum testosterone was statistically significant in all groups (P0.001). Changes in semen and hormone tests were not affected by the extent of weight loss experienced by patients. Weight loss from bariatric surgery had a favourable effect on serum testosterone levels and semen parameters of patients with pre-existing azoospermia and oligospermia.