Am Fam Physician. 2000;61(1):109-110
See related article on erectile dysfunction.
What is erectile dysfunction?
Erectile dysfunction is when men can't get a penile erection or can't keep an erection long enough to finish having sex. Erectile dysfunction is sometimes called “impotence,” although that's an older term that doctors aren't using as much these days.
Erectile dysfunction is a highly common problem. Ten to 20 million men in the United States have erectile dysfunction to some degree. The chance of having problems with erection increases as men age, but many older men have no problems at all.
What causes erectile dysfunction?
Many medical conditions, the use of certain medicines and psychologic problems may cause erectile dysfunction.
Blood Vessel Problems
The most common cause of erectile dysfunction is problems with the blood vessels that carry blood to the penis. In some men, the blood vessels narrow and don't allow the increased blood flow needed for a full erection.
Conditions that cause the blood vessels to narrow include atherosclerosis (hardening of the arteries), high blood pressure, high cholesterol levels and long-term smoking.
During a normal erection, signals from the brain and spinal cord are sent through nerves to the blood vessels in the pelvis and the genitals. These signals cause the blood vessels to widen and allow the penis to fill with blood and become erect.
Many conditions can interfere with these signals, causing erectile dysfunction. Damage to the nerves may be caused by stroke or spinal cord injury, or may occur during prostate surgery or other types of surgery. Diabetes and long-term heavy alcohol use can also damage the nerves' ability to send signals.
Men who don't make enough testosterone (male hormone) may have problems achieving an erection. However, low hormone levels more commonly affect a man's interest in sex (libido) rather than the ability to have an erection. Other hormone abnormalities may also cause erection problems.
Use of Medicines
Many medicines can affect the ability to have sex. Medicines can decrease the ability to have an erection. Medicines can also affect the level of interest in sex and the ability to have an orgasm.
Medicines used to treat high blood pressure, heart disease, depression and heartburn are among the most common medicines that interfere with the ability to have an erection.
Depression, anxiety or stress may also cause problems with erectile function. In some men, not feeling satisfied with their sexual function may lead to depression or other psychologic symptoms.
How is erectile dysfunction treated?
The most effective treatment depends on the cause of the erectile dysfunction. Lifestyle changes, such as quitting smoking, drinking less alcohol, reducing stress and strengthening relationships may improve erectile function. Adjusting regularly used medications and identifying and treating certain medical conditions may also improve erectile function. Pills to aid erectile ability, vacuum devices, and medication placed in the penis are additional treatment options available.
If you have erectile dysfunction, you and your family physician should work together to decide what treatment is best for you.
Where can I get more information?
You can obtain more information about erectile dysfunction by contacting the following organizations:
National Kidney and Urologic Diseases
3 Information Way
Bethesda, MD 20892-3560
Web site: http://www.niddk.nih.gov
American Foundation for Urologic Disease
1128 North Charles St.
Baltimore, MD 21201
Web site: http://www.afud.org
Impotence World Association
P.O. Box 410
Bowie, MD 20718-0410
Web site: http://www.impotenceworld.org
Impotence Information Center
P.O. Box 9
Minneapolis, MN 55440