Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, is defined as a man’s inability to achieve and maintain an erection that is sufficient for satisfactory sexual intercourse. The ability to have an erection requires the normal, integrative functions of the nerves, blood vessels, muscles and brain.

ED is a common condition affecting an estimated 20 to 30 million men in North America and over 150 million men worldwide.

The greatest medical risk factors for erectile dysfunction include:

  • Diabetes mellitus
  • Heart disease
  • Hypertension
  • Having a decreased high-density lipoprotein level
  • Radiation therapy and surgery for prostate or bladder cancer

ED may result from a variety of factors or a combination of factors. These may include:

  • Psychological causes, such as performance anxiety, a strained relationship, lack of sexual arousability and mental health disorders, including depression and schizophrenia.
  • Neurological disorders, including Parkinson’s disease, Alzheimer’s disease, stroke and brain trauma. These conditions often cause erectile dysfunction by decreasing libido or preventing the initiation of an erection.
  • Hormonal disorders, such as hyperprolactinemia and androgen deficiency, which can decrease nocturnal erections and libido.
  • Vascular conditions and factors, including heart disease, hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus and pelvic irradiation. A disorder called, veno-occlusive dysfunction, in which the veins are unable to close during an erection, also can cause erectile dysfunction.
  • Certain medical drugs, such as antipsychotic, antidepressant and centrally acting antihypertensive drugs, may disturb the pathways involved in sexual function. Other drugs known to cause erectile dysfunction include Cimetidine, a histamine H2-receptor antagonist, estrogens and drugs with antiandrogenic action, such as ketoconazole and cyproterone acetate.
  • Smoking cigarettes
  • Drinking large amounts of alcohol, as well as suffering from chronic alcoholism, also can cause erectile dysfunction.
  • Other factors, such as old age and chronic renal failure, can also contribute to erectile dysfunction.

The hallmark symptom of erectile dysfunction is the inability to achieve and maintain an erection for satisfactory sexual intercourse. This condition also may involve problems with emission, ejaculation and orgasm.

It is important to note that it is not necessary to have an erection to have an orgasm. A vibrator or creative and attentive partner can be helpful.

There are a variety of treatment options available for erectile dysfunction, which will be explained to you by your doctor. Your therapy will depend on the cause of ED, your age, your health and you and your doctor’s preferences.

Treatments include:

  • Oral medication, such as Viagra, Levitra or Cialis
  • Urethral suppository (MUSE) — uses a small suppository of medication that is placed in the penile uretha without needles. The suppository is then absorbed and helps to produce an erection.
  • Penile injections
  • Vacuum device
  • Microvascular surgery — for patients who have blood vessel blockage or leakage
  • Penile prosthesis — for men who do not tolerate or respond to other treatments
  • Penile Vascular Reconstructive Surgery — recommended only for young men who have ED as result of congenital or traumatic venous leakage of the penis