ED is the inability to get or keep an erection firm enough for sexual intercourse. ED can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.ED is sometimes called impotence, but that word is being used less often so that it will not be confused with other, nonmedical meanings of the term.
The National Institutes of Health estimates that ED affects as many as 30 million men in the United States. Incidence increases with age: About 4 % of men in their 50s and nearly 17 % of men in their 60s experience a total inability to achieve an erection. The incidence jumps to 47 % for men older than 75. But ED is not an inevitable part of aging. ED is treatable at any age.ED usually has a physical cause, such as disease, injury, or side effects of drugs.
Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.Because an erection requires a precise sequence of events, ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.
Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of ED. Diseases, such as diabetes, high blood pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart disease, account for the majority of ED cases. Patients should be thoroughly evaluated for these conditions before they begin any form of treatment for ED.
Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are possible causes of ED.Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous tissues of the corpora cavernosa.
In addition, ED can be a side effect of many common medicines such as blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine, an ulcer drug.Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure can also cause ED. Hormonal abnormalities, such as low levels of testosterone, are a less frequent cause of ED.
Most doctors suggest that treatments proceed from least to most invasive. Making a few healthy lifestyle changes may solve the problem. Quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help some men regain sexual function.
Cutting back on or replacing medicines that could be causing ED is considered next. For example, if a patient thinks a particular blood pressure medicine is causing problems with erection, he should tell his doctor and ask whether he can try a different class of blood pressure medicine.