Erectile Dysfunction (Impotence)

Erectile dysfunction (ED), also known as impotence, is the inability to get or maintain an erection firm enough for sexual intercourse. It's a common condition affecting millions of men worldwide, becoming more prevalent with age but not an inevitable part of aging. ED can result from physical problems, psychological issues, or a combination of both. While occasional erection problems are normal, persistent ED can impact self-confidence, relationships, and quality of life. Understanding that ED is often a sign of underlying health conditions and that effective treatments are available is crucial for seeking appropriate help.

🚨 Seek Medical Care If:

You have sudden complete loss of erections (may indicate vascular emergency), painful erections lasting >4 hours (priapism - medical emergency), ED with chest pain or breathing problems, or penile deformity with pain. These require immediate evaluation to prevent permanent damage.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

Understanding Erectile Dysfunction

Normal Erectile Function

Erections involve complex interactions between:

  • Brain and psychological factors
  • Nervous system
  • Blood vessels
  • Hormones
  • Muscles

Types of ED

  • Primary ED: Never been able to achieve erection
  • Secondary ED: Previously had normal function
  • Situational ED: Only in certain circumstances
  • Complete ED: Unable to achieve any erection
  • Partial ED: Inadequate for penetration

Common Causes

Vascular Causes (Most Common)

  • Atherosclerosis:
    • Narrowed blood vessels
    • Reduced blood flow to penis
    • Same process as heart disease
    • ED often precedes heart problems
  • High blood pressure:
    • Damages blood vessels
    • Medications can worsen ED
    • Common in middle age
  • Diabetes:
    • Damages nerves and vessels
    • 50% of diabetic men have ED
    • Earlier onset than non-diabetics
  • Heart disease:
    • Shared risk factors
    • ED as early warning sign
    • Important to evaluate

Neurological Causes

  • Spinal cord injury: Level determines severity
  • Multiple sclerosis: Progressive nerve damage
  • Parkinson's disease: Affects autonomic function
  • Stroke: Can affect erectile centers
  • Nerve damage: From surgery or radiation
  • Peripheral neuropathy: Often from diabetes

Hormonal Causes

  • Low testosterone:
    • Decreased libido
    • Fatigue
    • Mood changes
    • Can be treated
  • Thyroid disorders:
    • Both hyper and hypothyroidism
    • Affects metabolism
    • Treatable cause
  • Hyperprolactinemia:
    • Elevated prolactin
    • May indicate pituitary problem
    • Reduces testosterone

Psychological Causes

  • Performance anxiety:
    • Fear of failure
    • Self-perpetuating cycle
    • Common in younger men
  • Depression:
    • Reduced interest
    • Medications can worsen
    • Bidirectional relationship
  • Stress:
    • Work pressure
    • Financial concerns
    • Relationship issues
  • Relationship problems:
    • Communication issues
    • Lack of attraction
    • Unresolved conflicts

Medications

  • Blood pressure medications:
    • Beta-blockers
    • Diuretics
    • Some ACE inhibitors
  • Antidepressants:
    • SSRIs especially
    • Can affect desire and function
  • Other medications:
    • Antihistamines
    • Acid reflux medications
    • Opioid pain medications
    • Anti-androgens for prostate
    • Chemotherapy drugs

Lifestyle Factors

  • Smoking: Damages blood vessels
  • Alcohol: Depresses nervous system
  • Obesity: Multiple mechanisms
  • Sedentary lifestyle: Poor circulation
  • Drug use: Cocaine, marijuana, etc.
  • Cycling: Prolonged pressure

Other Causes

  • Peyronie's disease: Penile curvature
  • Sleep disorders: Sleep apnea
  • Chronic kidney disease: Multiple factors
  • Liver disease: Hormone imbalances
  • Radiation therapy: Pelvic area
  • Prostate surgery: Nerve damage

Diagnosis and Evaluation

Medical History

  • Onset and duration of ED
  • Morning erections (indicates vascular health)
  • Libido levels
  • Relationship status
  • Medications
  • Lifestyle factors
  • Medical conditions
  • Psychological factors

Physical Examination

  • Blood pressure
  • Genital examination
  • Prostate check
  • Neurological assessment
  • Vascular evaluation
  • Secondary sex characteristics

Laboratory Tests

  • Basic tests:
    • Testosterone levels
    • Blood glucose
    • Lipid profile
    • Thyroid function
  • Additional tests:
    • Prolactin
    • PSA
    • Complete blood count
    • Liver/kidney function

Specialized Tests

  • Nocturnal penile tumescence: Sleep erection monitoring
  • Doppler ultrasound: Blood flow assessment
  • Injection test: Response to medication
  • Angiography: Rarely needed
  • Psychological evaluation: If indicated

Treatment Options

Oral Medications (First Line)

  • PDE5 inhibitors:
    • Sildenafil (Viagra)
    • Tadalafil (Cialis)
    • Vardenafil (Levitra)
    • Avanafil (Stendra)
    • 70% effective
    • Various durations of action
  • Contraindications:
    • Nitrate medications
    • Severe heart disease
    • Recent stroke/MI
    • Low blood pressure

Other Medications

  • Testosterone replacement: If low levels
  • Alprostadil injections: Self-administered
  • Alprostadil suppository: Urethral insertion
  • Combination therapy: Multiple approaches

Devices and Surgery

  • Vacuum erection devices:
    • Creates erection mechanically
    • Ring maintains erection
    • No medications needed
  • Penile implants:
    • Inflatable or malleable
    • High satisfaction rates
    • Permanent solution
  • Vascular surgery:
    • Young men with trauma
    • Specific vascular lesions

Psychological Treatment

  • Sex therapy
  • Couples counseling
  • Cognitive behavioral therapy
  • Stress management
  • Treatment of depression/anxiety

Lifestyle Modifications

  • Weight loss
  • Exercise regularly
  • Quit smoking
  • Limit alcohol
  • Manage stress
  • Improve diet
  • Better sleep

Living with ED

Communication

  • Open discussion with partner
  • Reduce performance pressure
  • Explore alternatives
  • Seek support together

Emotional Impact

  • Common feelings of inadequacy
  • Impact on self-esteem
  • Relationship stress
  • Importance of support

When to Seek Help

  • ED lasting >3 months
  • Sudden onset ED
  • ED with other symptoms
  • Relationship problems
  • Emotional distress
  • Failed self-treatment