Erectile dysfunction (ED) is the inability to achieve or maintain an erection on a regular basis. Figure 01 In order to have an erection, a series of events must occur, including signals from the brain and spine to the muscles and veins of the penis. When this series of events is disrupted by physical damage, disease, drug side effects, or psychological conditions, erectile dysfunction or impotence can result. Erectile dysfunction may occur with every sexual encounter, or may occur intermittently. A man is considered to be impotent if he cannot get or maintain an erection sufficient for intercourse in 25% of attempts. Aside from the inability to get or maintain an erection, ED also may be linked to the inability to ejaculate.
The incidence of ED increases with age. In men between the ages of 40 and 70, 25% have at least a moderate degree of ED. An estimated 30% of men have had erectile dysfuntion at some point in their lives.
Many treatments exist for improving erectile dysfunction. Once the cause of ED is identified, medications or other treatments are available to help men have and maintain their erections. Doctors usually start with the least invasive treatment before trying the more invasive ones. First, a doctor might recommend that a patient cut back on drugs that may have erectile dysfunction as a side effect (e.g., nicotine from cigarettes; anti-depressives; and many other medications). A visit to a psychotherapist may be needed to address any psychological or emotional issues, depending on the individual situation. Other therapies such as vacuum devices, oral drugs, injected drugs, or surgery to repair damaged tissue or implant devices may be also recommended.
Extensive diagnostic testing is usually not necessary, as effective medications are now available. The most widely known of these is sildenafil citrate (Viagra, Cialis, and Levitra), which is used by 90% of men with ED.
Figure 01. Male reproductive anatomy
A surgical procedure that damages blood vessels and tissues can cause erectile dysfunction. Prostate or spinal surgery may injure important nerves, blood vessels, and surrounding tissues that are important in generating or maintaining an erection. As long as at least some of these important structures remain intact, therapies can restore erectile function.
Erectile dysfunction is more prevalent in men who take certain drugs or medications. Examples include alcohol and tobacco, or medications used to treat diabetes, depression, anxiety, high blood pressure, or heart disease. Antihistamines or antacids (specifically cimetidine) may also contribute to ED.
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