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Erectile Dysfunction or ED
Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection
firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that
interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation
or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.
In older men, 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. Incidence
increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED.
But it is not an inevitable part of aging.
Erectile dysfunction, or ED, can be a total inability to achieve erection, an inconsistent ability to do so, or a
tendency to sustain only brief erections. These variations make defining ED and estimating its incidence difficult.
Estimates range from 15 million to 30 million, depending on the definition used.
Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS
data on new drugs show an estimated 2.6 million mentions of Viagra at physician office visits in 1999, and one-third of those
mentions occurred during visits for a diagnosis other than ED.
How does an erection occure?
The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1).
A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea.
The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel
for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.
The most common cause of ED is damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease.
Diseases—such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and
neurologic disease—account for about 70 percent of ED cases. Between 35 and 50 percent of men with diabetes experience ED.
Also, surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near
the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming
nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
How is ED treated?
Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle
changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men
regain sexual function.
Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally
injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be
considered.
- Psychotherapy
- Drug Therapy
- Vacuum Devices
- Surgery