What is erectile dysfunction (ED)?
Impotence, or erectile dysfunction, is the inability to achieve an erection, and/or dissatisfaction with the size, rigidity, and/or duration of erections. According to the National Institutes of Health, erectile dysfunction affects up to 30 million men.
Although in the past it was commonly believed to be due to psychological problems, it is now known that for most men erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.
What are the different types (and causes) of ED?
The following are some of the different types and possible causes of impotence:
- premature ejaculation (PE) Premature ejaculation is the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms:
- primary premature ejaculation Primary premature ejaculation is a learned behavior that begins when a male first become sexually active. Like any learned behaviors, it can be unlearned. This form of primary PE is psychogenic (as opposed to organic or physical) impotence. (Congenital venous leak is a subset of primary PE and is caused by a congenital venous leak in which the venous drainage system in the penis does not shut down properly.)
- secondary premature ejaculation Secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. Secondary PE is due to physical causes, usually involving the penile arteries, veins, or both.
- performance anxiety Performance anxiety is a form of psychogenic impotence, usually caused by stress or anxiety.
- Depression Depression is another cause of psychogenic impotence. Some antidepressant medications cause erectile failure.
- organic impotence Organic impotence involves the penile arteries, veins, or both and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis – being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking – can cause erectile failure often before progressing to affect the heart. Many experts believe that when veins are the cause, a venous leak or “cavernosal failure” is the most common vascular problem.
- diabetes Impotence is common in persons with diabetes. There are 10.9 million adult men in the US with diabetes, and it is estimated that 35 percent to 50 percent are impotent. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in persons with diabetes.
- neurologic causes There are many neurological (nerve problems) causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.
- drug-induced impotence A great variety of prescription drugs, such as blood pressure medications, anti-anxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with impotence.
- hormone-induced impotence Hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence. Rarely is low testosterone responsible for impotence.
Treatment for ED:
Specific treatment for erectile dysfunction will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference