Men who are regularly unable to have or maintain an erection suitable for sexual intercourse are suspected of having erectile dysfunction. Normally, aroused men receive impulses from the brain and spine that prompt the penis to fill with blood, causing an erection. If these signals are blocked, men are unable to get or maintain an erection.
Certain diseases may make men more likely to suffer from erectile dysfunction. Some diseases can damage the blood vessels, tissues, and muscles that are involved in maintaining signals from the brain and spine to the penis. A common example is diabetes mellitus, which can damage both the nerve and blood supply to the penis. Between 35% and 50% of diabetic men have ED.
Diseases that may cause erectile dysfunction include:
- Kidney disease
- Chronic alcoholism
- Multiple sclerosis (MS)
- Heart disease
Mental or emotional states may predispose men to ED. In 10% to 20% of cases, mental or emotional factors cause ED. Men who experience stress, anxiety, guilt, depression, low self-esteem, and/or fear of sexual failure may have erectile dysfunction. These factors usually cause impotence in younger men.
Smoking is a risk factor of ED. Smoking may damage blood vessels. These damaged blood vessels may block signals from the brain and spine to the penis—signals that are needed for having and maintaining an erection.
Older men may be more likely to have ED. Between the ages of 40 and 65, the incidence of ED rises from 5% to nearly 25%.
In some cases, hormonal abnormalities such as low testosterone can predispose men to ED. In general, men with testosterone deficiency, even if it is severe, are still able to get and maintain erections. However, their nighttime erections are likely to be reduced in both frequency and intensity. Nevertheless, unless there is a contraindication, testosterone replacement therapy is always offered to men with low testosterone levels.
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