Erectile dysfunction, also known as “impotence,” is the repeated inability to get or keep an erection firm enough for sexual intercourse.

Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners to one extent or another. The term erectile dysfunction,  previously known as impotence, covers a wide range of disorders, but usually refers to the inability of a man to achieve or maintain an erection sufficient enough to fulfill his own sexual needs or those of his partner.

As men age, it's quite normal to experience changes in erectile function. Erections  may take longer to develop,  may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate reduces and refractory period between erections increases. An occasional episode of erectile dysfunction happens to most men but they are not psychologically affected by it Some men, however, experience chronic and complete erectile dysfunction, while others have the ability to achieve  partial or brief erections.  Frequent erectile  dysfunction  can cause  emotional  and relationship  problems,  which often lead to low self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging. Although erectile dysfunction is more common in men older than 40, it can occur at any age

Symptoms of Erectile dysfunction

Erectile dysfunction can be classified into the following patterns:

  • Occasional inability to achieve a full erection
  • Inability to maintain an erection during sexual intercourse
  • Complete inability to achieve an erection

The Anatomy of the Penis

The  penis  consists  of  two  cylindrical,  sponge-like  vascular  tissue  bodies (corpora cavernosa) that run along its length, parallel to the urethra – the tube that expells semen and urine. Also present are the erectile tissue surrounding the urethra, two main arteries and several veins and nerves. The longest part of the penis is the shaft, at the end of which is the head (glans penis). The opening at the tip of the glans is the meatus, which allows for urination and ejaculation.

The Mechanism of an Erection

When a man is sexually aroused, nerve impulses lead to a relaxing action and cause about a seven-fold increase in the blood flow to these cylinders. This sudden influx of blood expands the sponge-like chambers and produces an erection  by  straightening,  elongating  and  stiffening  the  penis.  Continued sexual excitation maintains this rush of blood, keeping the erection firm. After ejaculation, or when the sexual excitation ceases, the excess blood drains out of the spongy tissue, and the penis returns to its flaccid state.

The Causes of Erectile Dysfunction

If something affects any of the above factors that lead to a full erection, or the delicate balance among them, erectile dysfunction may result. Erectile dysfunction may have physical as well as nonphysical causes.

Physical Causes

Physical causes account for about 80% cases of erectile dysfunction and may include:

  • Diabetic neuropathy – nerve damage from chronic diabetes
  • Cardiovascular disorders that might affect blood supply to the pelvis
  • Certain prescription medications available in the market
  • Operations e.g. removal of the prostate gland
  • Fractures that might injure the spinal cord
  • Multiple sclerosis
  • Hormonal disorders
  • Alcoholism or other forms of drug abuse

Non physical causes

Nonphysical causes may account for the remaining 20% cases of impotence observed. These may include:

Psychological problems – stress, anxiety, fatigue and depression.

Negative feelings – resentment, hostility or lack of interest exhibited by any of the two partners.

The physical and nonphysical causes of ED generally tend to interact. A minor physical  problem  that  slows  sexual  responses  may  cause  anxiety  about attaining an erection and this anxiety in turn can worsen erectile dysfunction.

Risk factors as a result of Erectile Dysfunction

Erectile dysfunction  may be one of the first signs of an underlying medical problem. A wide variety of physical and emotional risk factors can contribute to erectile dysfunction.

– Physical  diseases  and disorders:  Chronic  diseases  of the lungs,  liver, kidneys, heart, nerves, arteries/ veins, disorders of the endocrine system, diabetes can lead to ED. The accumulation of plaques in arteries (atherosclerosis)  can  prevent  adequate  amount  of blood  from  entering  the penis.   Erectile   dysfunction   may   be  caused   by  reduced   levels   of   the testosterone hormone in some men.

– Surgery or trauma: Damage to the nerves that control erections can cause ED. Such damage may result from an injury to the pelvic area or the spinal cord. Surgery to treat bladder, rectal or prostate cancer also can result in ED. Prolonged bicycle riding also can cause a temporary erectile problem.

–   Medications:    A   wide   range   of   drugs   such   as   antidepressants, antihistamines,  painkillers and medications to treat high blood pressure and prostate cancer can cause ED by obstructing proper functioning of nerve impulses or blood supply to the penis. Tranquilizers  and sleeping aids also may pose a problem.

– Substance abuse: Chronic use of alcohol, marijuana or other drugs often causes  ED  and  a  decrease  in  sexual  drive.  Excessive  tobacco  use  may damage penile arteries and thus contribute to ED.

– Stress, anxiety or depression: Psychological conditions also contribute to some cases of erectile dysfunction.

Occurrence and Prevalence of Erectile Dysfunction

Because of the various definitions attributed to ED, estimating the incidence of cases becomes a little difficult. According to the National Institutes of Health (NIH) in 2002, an estimated 15 – 30 million men in the US suffer from chronic erectile  dysfunction.  According  to  the  National  Ambulatory  Medical  Care Survey (NAMCS) in 1999, around 22 of every 1000 men in the US sought medical attention for ED.

Incidence of erectile dysfunction increases with progressing age. Chronic ED

affects about 5% of men in their 40s and 15–25% of men around the age of

65. Temporary ED and incomplete erection affect up to 50% of men between

40 and 70 years of age.

Diseases   like  diabetes,   kidney  disease,   alcoholism   and  atherosclerosis account for as high as 70% of chronic ED cases while psychological factors

such as stress, anxiety and depression may account for about 10 – 20% of the total number of cases. Around  35-50%  of men suffering from diabetes also experience ED.

Diagnosis of Erectile Dysfunction

Initially the physician conducts a thorough investigation to determine how and when the disorder was developed; and if other physical conditions exist and prepares a checklist of medications used, if any. Physical and emotional situations are also discussed, because a noteworthy number of ED cases can be traced to psychological origins. If an apparent physical cause is suspected, blood tests are first taken to check male hormone levels and also to eliminate a list of potential  diseases  such as diabetes.  Additional  specialized  clinical tests may also be done

Penile nerve function: Determines adequacy of nerve sensation in the penis Duplex  Ultrasound:  Assesses  adequacy  of arterial  circulation  in the penis. Nocturnal Penile Tumescence (NPT): Measures changes in penile rigidity and girth   during   nocturnal   erections.   Cavernosometry:    Measures   vascular pressure in the penis.

Measures to Reduce The Chances of Erectile Dysfunction

Although most men experience episodes of erectile dysfunction from time to time, the following steps may be taken to decrease the likelihood of ED occurrences:

– Limited use of alcohol and similar substances.

– No Smoking.

– Regular exercise.

– Stress, anxiety and depression management.

– Sound sleep.

– Regular checkups and medical screening tests.

Coping with Erectile Dysfunction

Whether the resulting disorder has physical or psychological origins or a combination of both, ED can become a source of mental and emotional stress for both the man and his partner. If you experience ED occasionally, do not assume that you have a permanent problem or expect it to occur again during your next sexual encounter. Don't consider one episode of erectile dysfunction as a lasting comment on your masculinity, virility or general health.

If you experience occasional or persistent ED, remember that it is important to reassure your partner that your inability to have an erection is not a sign of diminished sexual desire. Try to communicate openly and honestly with your partner about your condition and strengthen the relationship you share with her. Couples  may also want to seek counseling  to deal with any concerns they may have regarding ED and to learn how to discuss their feelings with each   other. 

Good   communication   must   be   maintained   throughout   the diagnosis and treatment process. In fact, treatment is often more successful if the couple works together as a team