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A-to-Z-Disease

      Erectile Dysfunction / Impotence

      What is erectile dysfunction (ED)?

      Impotence, or erectile dysfunction (ED), may result from the total inability to achieve erection, an inconsistent ability to achieve an erection, or the ability to only sustain a brief erection. According to the National Institutes of Health (NIH), up to 30 million men are affected by ED, depending on the definition used.

      Although in the past it was commonly believed to be due to psychological problems, it is now known that for most men erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of ED.

      What are the causes of erectile dysfunction?

      According to the National Institutes of Health (NIH), ED also is a symptom in many disorders and diseases. Causes of ED include the following:

          * premature ejaculation (PE)
            Premature ejaculation is the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms. Primary premature ejaculation is a learned behavior that begins when a male first becomes sexually active (as opposed to organic or physical) impotence. Secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. Secondary PE is due to physical causes, usually involving the penile arteries, veins, or both.
          *  performance anxiety
            Performance anxiety is a form of psychological impotence, usually caused by stress or anxiety.
          * depression
            Depression is another cause of psychological impotence. Some antidepressant medications cause erectile failure.
          * organic impotence
            Organic impotence involves the penile arteries, veins, or both, and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis - being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking - can cause erectile failure often before progressing to affect the heart. Many experts believe that when veins are the cause, a venous leak or "cavernosal failure" is the most common vascular problem.
          * venous leak
            Venous leak may be caused when the veins in the penis cannot prevent blood from leaving the penis during erection. This may be congenital or result from damage to the veins of the penis.
          * diabetes
            Impotence is common in persons with diabetes. There are 10.9 million adult men in the US with diabetes, and it is estimated that 35 percent to 50 percent are impotent. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in persons with diabetes.
          *  neurologic causes
            There are many neurological (nerve problems) causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause ED.
          * drug-induced impotence
            A great variety of prescription drugs, such as blood pressure medications, anti-anxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with impotence.
          * hormone-induced impotence
            Hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence. Rarely is low testosterone responsible for impotence.
          *  Peyronie's disease
            Peyronie's disease is a rare inflammatory condition that causes scarring of erectile tissue that may result in curvature of the penis. This condition can impair sexual function.

      Treatment for ED:

      Specific treatment for erectile dysfunction will be determined by your physician based on:

          * your age, overall health, and medical history
          * extent of the disease
          * your tolerance for specific medications, procedures, or therapies
          * expectations for the course of the disease
          * your opinion or preference