Men's Health

Men's Health Conditions

Erectile Dysfunction / Impotence

What is erectile dysfunction (ED)?

Impotence, or erectile dysfunction, is the inability to achieve or maintain an erection more than 20 percent of the time. Erectile dysfunction affects millions of men.

Although in the past it was commonly believed to be due to psychological problems, it is now known that 80-90 percent of impotence is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.

What are the risk factors for ED?

According to the National Institutes of Health, erectile dysfunction is also a symptom in many disorders and diseases.

Direct risk factors for erectile dysfunction may include:

prostate problems
type 2 diabetes (diabetes mellitus)
hypogonadism in association with a number of endocrinologic conditions
hypertension (high blood pressure)
vascular disease and vascular surgery
high levels of blood cholesterol
low levels of HDL (high density lipoprotein)
drugs
neurogenic disorders
Peyronie's disease (distortion or curvature of the penis)
priapism (inflammation of the penis)
depression
alcohol ingestion
lack of sexual knowledge
poor sexual techniques
inadequate interpersonal relationships
many chronic diseases, especially renal failure and dialysis
smoking, which accentuates the effects of other risk factors such as vascular disease or hypertension

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

It is estimated that two men in five have problems getting an erection at age 40, and nearly seven in 10 at age 70. Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

What are the different types (and causes) of ED?

premature ejaculation (PE) - the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms.

primary premature ejaculation is a learned behavior that begins when a male first becomes sexually active. Like any learned behavior, it can be unlearned. This form of primary PE is psychogenic (as opposed to organic or physical) impotence.

(Congenital venous leak is a subset of primary PE and is caused by a congenital venous leak in which the venous drainage system in the penis does not shut down properly.)

secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. Secondary PE is due to physical causes, usually involving the penile arteries or veins or both.

performance anxiety is a form of psychogenic impotence usually caused by stress or anxiety.

depression is another cause of psychogenic impotence. Also, some antidepressant medications may cause erectile failure.

organic impotence involves the penile arteries, veins or both, and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis -- being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking -- can cause erectile failure often before progressing to affect the heart. Many experts believe that when veins are the cause, a venous leak or "cavernosal failure" is the most common vascular problem.

diabetes - impotence is common in persons with diabetes. There are 5 million diabetic adult men in the US, and it is estimated that half are impotent and the other half will become impotent in time. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in persons with diabetes.

neurologic causes - there are many neurological (nerve problems) causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.

drug induced impotence - a great variety of prescription drugs, such as blood pressure medications, anti-anxiety and anti-depressant drugs, glaucoma eye drops, and cancer chemotherapy agents are just some of the many drugs associated with impotence.

hormone induced impotence - hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence. Rarely is low testosterone responsible.

How is ED commonly diagnosed?

patient medical/sexual history - may reveal conditions or diseases that lead to impotence and helps distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

physical examination - to look for evidence of systemic problems, such as:

a problem in the nervous system may be involved if the penis does not respond as expected to certain touching

secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involves the endocrine system

circulatory problems could be indicated by an aneurysm

unusual characteristics of the penis itself could suggest the basis of the impotence

laboratory tests - to help diagnose impotence include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. When low sexual desire is a symptom, measurement of testosterone in the blood can yield information about problems with the endocrine system.

other tests - to help rule out certain psychological causes of impotence.

psychosocial examination - to help reveal psychological factors. The sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse.

Treatment for ED:

Specific treatment for erectile dysfunction will be determined by your physician(s) based on:

your overall health and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Treatment may include:

drug therapy -- medications can be:
- taken orally
- injected directly into the penis
- inserted into the urethra at the tip of the penis

mechanical vacuum devices

surgery to:
- implant a device that can cause the penis to become erect
- reconstruct arteries to increase flow of blood to the penis
- block off veins that allow blood to leak from the penile tissues

psychotherapy -- primarily to decrease anxiety

This page was last updated on: February 1, 2008.

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