Erectile dysfunction (impotence)

Erectile dysfunction (impotence)

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Erectile dysfunction (ED) or impotence means you can’t get an erection. It can also mean you are dissatisfied with the size or hardness of your erections, or how long your erections last. In the past, ED was thought to be due to psychological problems. It is now known that for most men ED is caused by physical problems. These are most often related to the blood supply of the penis.

Causes of erectile dysfunction:


There are different types and causes of ED. These are some of the most common:
Premature ejaculation: This is the inability to keep an erection long enough for mutual pleasure.
Performance anxiety: This is most often caused by stress.
Depression: Being depressed can affect your ability to get an erection. Some anti-depressants cause erection problems, too.
Organic impotence: This involves the arteries or veins in the penis. It is the most common cause of ED, especially in older men. It can be related to hardening of the arteries throughout the body. Injury or a venous leak in the penis may also cause ED.
Diabetes: ED is common in men with diabetes. It causes early and severe hardening of the arteries. Problems with the nerves controlling erections are also often seen in men with diabetes.
Neurologic causes: Several neurological problems can lead to ED. For instance, multiple sclerosis, stroke, and spinal cord and nerve injuries. Nerve damage from pelvic surgeries can cause ED.
Medicine-induced impotence: Blood pressure medicines, anti-anxiety and anti-depressant medicines, glaucoma eye drops, and cancer chemotherapy medicines are just some of the many medicines that can cause ED.
Hormone-induced impotence: Hormone abnormalities, such as increased prolactin (a hormone made by the pituitary gland), steroid abuse by bodybuilders, too much or too little thyroid hormone, and hormones used to treat prostate cancer can all cause ED. Rarely, low testosterone causes ED.
Low testosterone: Rarely, low testosterone can be linked to ED.
Lifestyle choices: Smoking, excessive alcohol use, being overweight, and not exercising can also lead to ED.

Risk factors for erectile dysfunction:

ED is a symptom that is linked to many health problems such as:

  • Prostate problems
  • Type 2 diabetes
  • Hypogonadism (the testicles are not making hormones the way they should)
  • High blood pressure
  • Vascular disease and vascular surgery
  • Heart disease or heart failure
  • High cholesterol
  • Low levels of HDL (high-density lipoprotein)
  • Nervous system disorders
  • Peyronie disease (curvature of the penis)
  • Depression, stress, or anxiety
  • Alcohol use
  • Relationship problems
  • Many chronic diseases, especially kidney failure and dialysis
  • Smoking, which worsens the effects of other risk factors, such as vascular disease or high blood pressure

Sign and symptoms of erectile dysfunction:

The symptom of ED is the not being able to get or keep an erection firm enough for sex. ED can mean that you can’t get an erection at all. Or, it can mean you can’t get an erection consistently, or can only get brief erections.

Diagnosis of erectile dysfunction:

Diagnosis of ED may include:


  • Review of health and sexual history: This may reveal conditions that lead to ED. It can also help your healthcare provider tell the difference between problems with erection, ejaculation, orgasm, or sexual desire.
  • Physical exam: To look for an underlying problem, such as:
    i. A problem in the nervous system may be involved if your penis does not respond as expected to certain touching.
    ii. Secondary sex characteristics, such as hair pattern, can point to hormone problems, which involve the endocrine system.
    iii. Unusual characteristics of the penis itself could suggest the cause of ED.
  • Lab tests: These can include blood counts, urine tests, cholesterol test, and measurements of creatinine and liver enzymes. When low sexual desire is a symptom, checking testosterone in the blood can show problems with the endocrine system.
  • Penile ultrasound: This is used to measure the blood flow in the penis.
  • Psychosocial exam: This is done to help find psychological factors that may be affecting your performance. Your sexual partner may also be interviewed.


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