What is erectile dysfunction?

Erectile dysfunction, also known as impotence, is the inability of a male to achieve or maintain an erection to have sex. Erectile dysfunction is commonly the result of physical conditions, particularly in older men. Psychological factors are also an important contributor to erectile dysfunction, particularly for younger men where physical causes are less likely. Most men experience erectile dysfunction occasionally, but if it is ongoing and causing distress or relationship problems, you may want to talk to your doctor.

Psychological

Relating to, arising in, or affecting the mind.

Causes

Normally, the spongy tissue within the penis - the corpus cavernosum - becomes filled with blood and this results in an erection. In erectile dysfunction, this does not occur or the blood partially drains without achieving a full erection. Some causes are related to physical health and erectile dysfunction and can, therefore, be an indication of an underlying medical condition. Other causes can be psychological or lifestyle related.

During an erection, the spongy tissue (corpus cavernosum) fills with blood. 

Physical health

A number of lifestyle and physical health factors can cause erectile dysfunction, including:

  • Increasing age;
  • Heart disease that is associated with high cholesterol, high blood pressure (hypertension), diabetes and smoking;
  • Obesity;
  • Obstructive sleep apnoea;
  • Neurological conditions such as Parkinson's diseasemultiple sclerosis (MS) or stroke;
  • Low testosterone levels;
  • An under-active thyroid (hypothyroidism);
  • Structural problems such as Peyronie's disease (a condition that affects the sheath of erectile tissue of the penis);
  • Medications - some of the more commonly associated medications include those used for benign prostatic hypertrophy (BPH), some blood pressure medications (including thiazide diuretics, beta blockers and calcium channel blockers) and some antidepressants, and;
  • Recreational drug use including marijuana, cocaine, cigarettes and alcohol.

Psychological conditions

To achieve and maintain an erection, arousal comes from specific brain signals. Sometimes these signals or feelings are interfered with, leading to erectile dysfunction. Some psychological reasons for erectile dysfunction can include:

  • Stress;
  • Depression;
  • Anxiety about performance;
  • Traumatic past experiences;
  • Relationship difficulties, and;
  • Sexual boredom or disinterest.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Psychological

Relating to, arising in, or affecting the mind.

Testosterone

A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.

Signs and symptoms

Signs and symptoms of erectile dysfunction can include:

  • Trouble achieving an erection, and;
  • Trouble maintaining an erection.

It is normal to occasionally have trouble achieving or maintaining an erection, but you may want to discuss with your doctor if this is recurring. 

Methods for diagnosis

To diagnose erectile dysfunction, your doctor may ask you detailed questions about your symptoms. Tests to identify any underlying physical problems can also be performed. These include blood and urine tests to identify any underlying condition, such as diabetes.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.

Types of treatment

There are multiple treatment options available for erectile dysfunction. Depending on what is causing the condition, treatment can include the following:

Lifestyle changes

Reducing alcohol intake and quitting smoking can help improve the condition. Avoiding social drugs and promoting sexual feelings with your partner can also help.

Medications

Phosphodiesterase-5 (PDE-5) inhibitors, including sildenafil, vardenafil and tadalafil, all work by relaxing the muscles in the penis and allowing blood to flow and fill the penis more freely. Medications, such as alprostadil, are injected into the side or base of the penis to produce an erection. The benefit of injections are less side-effects, which are common with tablets or nasal sprays. These include headaches, flushing, dizziness and blocked nose.

If your doctor has identified that you have low testosterone, they may look at testosterone replacement therapy.

Counselling

Visiting a counsellor or psychologist can be useful if the cause of erectile dysfunction is psychological. Together with your partner, this can help to resolve any underlying relationship issues or confront self-esteem or performance issues.

Pumping devices

Pumping or vacuum devices can be used to draw and trap blood in the penis. A rubber ring is then placed at the base of the penis to keep it engorged and rigid for intercourse. Sometimes there can be side effects including numbness and difficulty ejaculating.

Surgical treatments

Vascular surgery can be used in cases where blood flow is restricted to the penis, sometimes following an accident or trauma. This procedure can open veins and arteries to allow more blood to flow to the penis. Prosthetic implants can also be surgically inserted into the penis. These are able to be inflated to control an erection. This treatment is likely to be suggested if treatment with medications has not worked.  

Psychological

Relating to, arising in, or affecting the mind.

Testosterone

A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.

Prosthetic implants

Artifical devices or tissues placed in or on the body to replace or enhance bodily tissues or parts.

Potential complications

Having erectile dysfunction for an extended period of time can sometimes lead to stress, anxiety, low self-esteem or depression. It can also be associated with relationship troubles.

Anxiety

A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.

Prognosis

Erectile dysfunction can be successfully treated. It is important to not be embarrassed, but rather discuss it with your doctor. It may be a sign of a more serious underlying medical condition. It can also lead to relationship issues, if not treated.

Prevention

To help prevent erectile dysfunction, it is important to monitor and treat any underlying medical conditions that you may have, such diabetes or hypertension. Cutting down your alcohol intake, not smoking, maintaining a healthy weight and maintaining a strong relationship with your partner can also help prevent erectile dysfunction.

Diabetes

A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterised by high blood sugar levels. Also known as diabetes mellitus.