Erectile dysfunction, also known as impotence, is the inability to acquire and maintain an erection in order to be able to engage in sexual intercourse. Men do not have to be concerned about infrequent erection problems that occur occasionally, but erectile dysfunction that is becoming an ongoing issue can be a serious problem, resulting in relationship difficulties, affecting self-confidence and causing stress.
Difficulties in acquiring and maintaining erections may also be an indication of a more serious health problem that may require medical treatment, and can even be a risk factor for heart disease later on.
Symptoms of erectile dysfunction can include difficulty getting and keeping an erection as well as a general reduction in sexual desire. You should see your family doctor if:
- You are worried about your erections, or have other sexual problems such as delayed or premature ejaculations
- You have other symptoms that go together with erectile dysfunction
- You have a known health condition such as diabetes or heart disease that may be linked to erectile dysfunction
Sexual arousal in males is a complicated process involving the brain, emotions, muscles, blood vessels, hormones and nerves, and problems with any of them can result in erectile dysfunction. Erectile dysfunction can also be caused or worsened by mental health concerns and stress. It can sometimes be caused by a combination of psychological and physical issues, such as the slowing of a sexual response caused by a minor physical complaint causing anxiety and stress, that in turn then makes the condition worse.
Physical causes A physical cause is the most common reason for erectile dysfunction, but there can be any number of conditions responsible such as:
- Heart disease
- High cholesterol
- Parkinson’s disease
- The development of scar tissue inside the penis (Peyronie’s disease)
- Use of tobacco
- Sleep disorders
- Injuries or surgeries affecting the spinal cord or pelvic area
- Atherosclerosis (clogged blood vessels)
- High blood pressure
- Metabolic syndrome (involving high insulin levels, high cholesterol, high waist body fat and increased blood pressure)
- Multiple sclerosis
- Some prescription medications
- Substance abuse including alcoholism
- Enlarged prostate and prostate cancer treatments
The brain has an important role to play in the sequence of physical events that result in an erection, which begins with feelings related to sexual excitement, but those feelings can be interfered with by a number of things that can cause erectile dysfunction or increase its severity, including:
- Relationship problems caused by poor communication, stress and other factors
- Stress from work or other sources
- Anxiety, depression and other mental health conditions
A physical exam and medical history will be all that is required for doctors to be able to diagnose erectile dysfunction in most men, and recommend a course of treatment. Consultation with a specialist (and sometimes more tests) may be required, if your doctor believes an underlying condition may be responsible, or if you suffer from chronic health problems. These tests could include a physical examination, ultrasound, urine and blood tests and a psychological exam. Another option is an overnight erection test which checks if men are having erections while asleep.
There are a number of options for treatment for erectile dysfunction, which will depend both on the severity and the cause of the condition, and whether there are any underlying health problems.
One successful treatment for erectile dysfunction for a lot of men is in the form of oral medications. The medications, including the famous Viagra, increase blood flow and enable an erection to form due to sexual stimulation, by enhancing the normal effects of the natural chemical produced by the body known as nitric oxide, which relaxes the penis muscles. Other medications include self-injections into the penis, testosterone replacement, penis pumps, penile implants and blood vessel surgery, although the latter is very rare. A new analysis from Portugal’s University of Porto has also found that men with erectile dysfunction could benefit from physical activity or exercise, with researchers finding that men who exercised experienced an improvement in their condition. Exercise may be used alone or with medications for erectile dysfunction.