Erectile dysfunction (ED)


Erectile dysfunction (ED) is the inability to attain or maintain penile erection during sexual intercourse. It is also commonly known as impotence. Erectile dysfunction could be primary or secondary. In primary ED, the affected person has never been able to attain or maintain an erection. In secondary ED, the affected person was previously able to attain and maintain erections but is unable to do so now.

ED seems to become more common during old age. However, it also occurs in young men and could indicate an underlying health problem that needs medical attention. ED is a treatable condition in most men. Sometimes the underlying problem is psychological and counseling is necessary rather than a medical approach.


The following are the main symptoms of erectile dysfunction.

  • The patient may have trouble getting penile erection, thereby preventing sexual intercourse.
  • The patient may get penile erections but is unable to maintain it for successful completion of sexual intercourse.
  • The patient may have decreased sexual desire.

These symptoms happen sporadically in all males sometimes due to fatigue and stress. In these cases it is usually a cause for concern. However, if these symptoms persist over a long time, one should get them checked by a doctor to rule out any underlying disease.


The causes of erectile dysfunction are many and can be broadly classified into two groups: psychological causes and physical causes.


These include mental stress, depression, and performance anxiety. Psychological causes lead to most of the cases of primary erectile dysfunction but are involved in only a minority of cases of secondary erectile dysfunction. However, even in cases of ED resulting from physical factors, psychological stress may ensue and worsen the problem.


Most of the cases of secondary ED have an underlying physical problem. Many of the physical causes of ED are associated with disorders of the blood vessels and the nervous system (like due to smoking, diabetes and atherosclerosis of blood vessels in the penis). Damage to the nerves of the penis during surgery (like prostate surgery) could also result in ED.

Stroke, seizures, multiple sclerosis, neuropathies and spinal cord injuries could also result in damage to the nerves of the penis, resulting in ED. Other physical causes of ED include hormonal disorders (like low testosterone levels) and the use of certain drugs (beta-blockers, diuretics, alcohol, opioids, tricyclic anti-depressants, amphetamines, anti-androgens, anti-cancer drugs, estrogen, anti-cholinergics).


The treatment of ED consists of the following options:

  • The first step is to get treatment for any underlying physical condition that could be causing ED. If the use of certain drugs is causing ED, those medications should be stopped. Lifestyle changes such as regular exercise, weight loss, and stopping smoking might also help.
  • The drugs of choice for treatment of ED are oral phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil). Direct injection of apomorphine and prostaglandins into the penis is another option.
  • Mechanical devices such as penis pumps, penile implants and constriction rings can be used to attain and maintain erection.
  • Surgical implantation of penile prosthesis is the last option when all the non-invasive treatments fail.

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