ERECTILE DYSFUNCTION

Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.[1] Through its connection to self-image and to problems in sexual relationships, erectile dysfunction can cause psychological harm.

 

Other names: Impotence

Specialty: Urology
Symptoms: Inability to gain or maintain an erection
Risk factors: cardiovascular disease, diabetes
 

In about 80% of cases, physical causes can be identified.[2] These include cardiovascular disease; diabetes mellitus; neurological problems, such as those following prostatectomy; hypogonadism; and drug side effects. About 10% of cases are psychological impotence, caused by thoughts or feelings;[2] here, there is a strong response to placebo treatment.

The term erectile dysfunction is not used for other disorders of erection, such as priapism.

Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial problems.[2] In many cases, treatment is attempted by drugs, specifically PDE5 inhibitors (such as sildenafil), which dilate blood vessels, allowing more blood to flow through the spongy tissue of the penis (akin to opening a valve further in order to allow more water to enter a fire hose). Other treatments, less commonly used, include prostaglandin pellets, inserted in the urethra; smooth-muscle relaxants and vasodilators, injected into the penis; penile implants; penis pumps; and vascular reconstructive surgery.[2][3]

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One ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".[26] Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation".[26] The U.S. Federal Trade Commission warns that "phony cures" exist even today.[27]
Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife.[28]:6, 18–19 Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex.[29] Medications by mouth and vacuum erection devices are first-line treatments,[28]:20, 24 followed by injections of drugs into the penis, as well as penile implants.[28]:25–26 Vascular reconstructive surgeries are beneficial in certain groups.[30] Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.[31]