Erectile Dysfunction - Overview

Introduction

What is erectile dysfunction (ED)?

Erectile dysfunction (ED) occurs when a consistent inability to get or maintain an erection prevents you from having satisfying sex. A man with ED either loses his erection before intercourse, gets only a partial erection, or gets no erection at all. ED is sometimes called impotence, but the preferred term is ED.

How common is ED?

Because ED is somewhat open to definition, it is tough to accurately estimate the number of sufferers. There is no universally agreed-upon criteria for how consistent an erection problem has to be and for how long it has to continue in order for it to qualify as ED. Plus, it can be hard to determine the number accurately because many men don't like to about it.

But some studies suggest that 20% of men in their 50s, and about 18 million Americans between the ages of 40 and 70, have ED to some degree. Worldwide, it's estimated that ED affects about 100 million men. And ED need not be chronic to make its presence felt. Other studies suggest that almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it's just temporary and needs only short term treatment.

Who typically gets ED?

Poor physical and emotional health can contribute to ED. ED also is associated with medical conditions such as diabetes, hypertension, high cholesterol and prostate disease. The more factors affect a man, the higher his risk of ED.

Age can also be a concern. ED is more likely to happen as a man gets older, particularly after he's 60. The occurrence of some degree of ED is 39% in men 40 years old, and 67% in those aged 70 years. ED can happen at any age, even after years of satisfying sex.

Nevertheless, age itself doesn't cause ED. Rather, it's the more frequent occurrence in of certain health issues in older men, such as vascular diseases and diabetes, that accounts for the increase in ED with age.

What are the common causes of ED?

Erections reflect the brain's complex interaction with the penis/pelvic area. Nerves and chemicals cause the penis muscles to relax and allow blood flow to the penis to increase, resulting in an erection. Anything that interferes with this intricate process can cause ED.

Common causes of ED include:

• Physiological disorders: Diabetes, high blood pressure, cholesterol elevation and some cardiovascular conditions can block blood vessels and impair blood flow to the penis. Certain hormone problems and medications can also cause ED.
• A stroke or multiple sclerosis, for example, can interfere with the brain's ability to communicate with the rest of the body. Such miscommunication during sexual functioning could cause ED. If different areas of the brain, nerves, or spinal cord are damaged, proper messages will not be relayed to the penis.
• Psychological: ED can stem from relationship problems, performance anxiety, stress (job, family, financial), a history of sexual abuse, guilt or fear associated with sexual behavior, and depression or other mental illnesses.

What health problems are associated with ED?

Impaired blood flow, either to or from the penis, is the most common cause of ED. Various diseases, such as diabetes, high blood pressure and hardening of the arteries (athersclerosis), can affect the flow of blood. In fact, atherosclerosis causes roughly 40% of ED in men older than 50 years.

Diseases affecting the nervous system can interfere with the body's ability to process sexual stimulation signals, also causing ED. Nerve damage from strokes or spinal injuries, and other neurological disorders, like multiple sclerosis and Parkinson's, change the brain's ability to respond to sexual stimulation, potentially preventing an erection.

Diabetes is a disease that affects both the vascular and nervous systems. Approximately 50% of diabetic patients, irrespective of type, have ED.

ED can also result from a fractured or crushed pelvis that leaves the man's nerves or arteries damaged, inhibiting the flow of blood to the penis.

Likewise, some types of pelvic surgeries and radiation therapies, such as those used in the treatment of prostate, bladder or rectal cancer, can cause ED.

Endocrine disorders such as low levels of testosterone, or thyroid or pituitary gland problems, can also cause a hormone imbalance and erectile problems.

Diseases such as Peyronie's disease, an inflammatory condition that produces scarring within the penis, causing it to curve or bend, can also contribute to ED.

Sometimes, medications taken to treat illnesses are behind ED. Blood pressure therapies like beta-blockers, some heart medications, some peptic ulcer medications, sleeping pills, and antidepressants fall into this classification.

Lifestyle choices may also contribute. Alcohol or other drug abuse, a poor diet and smoking may be associated with vascular disease, hardening of the arteries and high blood pressure--all of which are, in turn, associated with ED.

Other chronic-disease states associated with ED include: chronic renal failure; hepatic failure; Alzheimer's disease; sleep apnea; and chronic obstructive pulmonary disease.

Very often, a combination of several factors causes ED. As the number of risk factors or conditions often leading to ED increase, the man's risk of ED rises correspondingly.