is characterized by the regular or repeated inability to obtain or maintain an erection. It is analyzed in several ways:
Obtaining full erections at some times, such as nocturnal penile tumescence when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.
Other factors leading to erectile dysfunction are diabetes mellitus
Drugs (anti-depressants (SSRIs) and nicotine are most common)
Cavernosal disorders (Peyronie's disease)
Psychological causes: performance anxiety
, and mental disorders
Aging. It is four times more common in men aged in their 60s than those in their 40s.
Diseases such as diabetes mellitus and multiple sclerosis
(MS). While these two causes have not been proven they are likely suspects as they cause issues with both the blood flow and nervous systems.
is a key cause of erectile dysfunction. Smoking causes impotence
because it promotes arterial narrowing.
Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Erectile dysfunction is a common complication of treatments for prostate cancer
, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve erection. As far as inguinal hernia surgery
is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of patients with preoperative sexual dysfunction
, while, in most cases, it does not affect patients with a preoperative normal sexual life.
ED can also be associated with bicycling due to both neurological and vascular problems due to compression.
Treatment depends on the cause.
Exercise, particularly aerobic exercise during midlife is effective for preventing ED; exercise as a treatment is under investigation.:6, 18–19 For tobacco smokers, cessation results in a significant improvement.
Oral pharmacotherapy and vacuum erection devices are first-line treatments,:20,24 followed by injections of drugs into the penis, and penile implants.:25–26
Phosphodiesterase type 5 inhibitors
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that destroy the cyclic nucleotides cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). Phosphodiesterases exist in different molecular forms and are unevenly distributed throughout the body. One of the forms of phosphodiesterase is termed PDE5, and inhibiting PDE5 increases the amount of cGMP available in the blood supply to the penis, thus increasing blood flow. The PDE5 inhibitors sildenafil
), vardenafil (Levitra) and tadalafil
(Cialis) are prescription drugs which are taken orally.:20–21
A topical cream combining alprostadil
with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a first line treatment for erectile dysfunction.
Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.:25
Main article: penis pump
A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just
prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants
may be fitted surgically.