What is Erectile dysfunction
Erectile dysfunction is the term now normally used to describe the condition known as impotence. The word impotent suggests being weak or inadequate, which is how men may feel when they experience the condition. Use of the new term emphasises that it is a medical problem – not a personal failure.
In men, erectile dysfunction can be defined as being a persistent inability to get or keep an erection that is firm enough to attain sexual satisfaction. It should not be confused with the occasional incident when this occurs, which is an experience common to the vast majority of men for various reasons. These can include having had too much alcohol to drink, being overly-anxious about a new sexual partner, or being worried about current events in your life. The issue would only be classed as Erectile Dysfunction if it keeps happening again and again. Again, an erection once attained should be hard enough and last long enough to be satisfactory. Other conditions, like premature ejaculation, may interfere in this process but these are different problems, and would be treated differently.
Who does it affect?
Erectile dysfunction is a surprisingly common experience. It has been estimated that at least 1 in 10 men is affected to some extent yet, because of the embarrassment and even shame which has been attached to this condition, many men do not seek treatment. Growing older is a factor, with the number of those experiencing erectile dysfunction increasing with age, but it affects the entire range from the youngest to the oldest.
How do I find out what causes my erectile dysfunction?
It is important that all erectile dysfunction is reported to your doctor, as sometimes it can be an indicator of something physically wrong with you that has to be treated. Also, your doctor is in the best position to find the reason for your erectile dysfunction. Routine questions and tests will provide a guide to the cause and allow your doctor to decide what kind of treatment you might need to deal with it. This may involve referral to a specialist. Detailed information can be found at the website of the Impotence Association – www.sda.uk.net
What causes erectile dysfunction?
Erections result when a man is aroused in the lead up to sexual activity. With physical or mental stimulation leading to arousal, signals are sent out via the nervous system to release chemicals which enable an increased blood supply to flow into the penis.
The blood is not allowed to leave the penis very easily and this congestion, or engorgement, is what makes the penis hard enough to allow penetration. If any part of this process is interrupted then the inability to attain or maintain an erection can result.
Interference can develop from any of two main groups of causes – physical and psychological – but because these can interact with each other erectile dysfunction which originated from physical causes may be maintained by a combination of both.
Physical (organic) causes of erectile dysfunction
Vascular: Anything that affects the flow of blood to the penis can result in erectile dysfunction. The main culprit tends to be atherosclerosis, the condition that narrows arteries and which can result in poor blood circulation, high blood pressure, heart disease and stroke. Atherosclerosis causes about half the cases of erectile dysfunction in men over 50. Also, the veins through which the blood leaves the penis may not be working properly, allowing the blood to leave too soon.
Illnesses such as diabetes and multiple sclerosis can lead to an eventual deterioration of the nervous system, and as with stroke, the signals giving rise to an erection may be blocked. It has been estimated that as many as 71% of men with multiple sclerosis will experience erectile dysfunction.
Any injuries to the nervous system, whether as the result of an accident, surgery or other medical intervention can also affect those signals leading to erection. As many as 50% of those undergoing major prostate surgery develop erectile dysfunction.
Many drugs have an effect on sexual functioning. The erectile dysfunction caused by alcohol use is well known, but other recreational drugs can produce a similar outcome. The medications provided for the treatment of a variety of illnesses eg depression and high blood pressure can result in some degree of erectile dysfunction.
Diabetes, hypothyroidism and hypopituitarism are amongst the endocrine disorders which can cause erectile dysfunction. Diabetes is the most common condition in this category and it damages both nerves and blood vessels over time. 35% of all men with diabetes, and 60% of those aged over 50 may experience some degree of erectile dysfunction.
- Kidney disorders
About 75% of those on dialysis may experience erectile dysfunction, but this will usually improve with transplantation. Erectile dysfunction will also occur in about 40% of those with chronic renal failure.
- Psychological (psychogenic) causes of erectile dysfunction
Psychological factors on their own are estimated to be the cause of 20% of all the cases of erectile dysfunction and account for most of the difficulties in young men. They can also contribute towards its continuation in all age groups where physical causes are the main culprit, but the man’s reaction to what he sees as his “failure” has added a psychological impact.
A good indicator that "everything is in working order" and that it is probably a psychological cause is if a “morning erection” is still experienced. Feelings like fear, anger, distress and anxiety cause part of the nervous system to come into play which directly blocks the action of another part of the system involved in creating an erection. This is a natural reaction – our ancestors would find it more difficult to run from a predator with an erection in the way!
It is necessary to identify the causes of worry and try to remove these. They could include concern about personal relationships, work, family problems, health or even sexual “performance” with a new or old partner. It is often said that the brain is the biggest sex organ of them all – if it is too busy with other things, it will not be involved in arousal and the erection that follows.
Psychiatric conditions and the medication provided to treat these can also cause erectile dysfunction. Almost 90% of men with severe depression are affected. With Alzheimer’s disease, 53% of men are affected.