Impotence (Erectile Dysfunction)

Definition

Impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.

Causes

To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this engorgement. They prompt the blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

The following factors can cause erectile dysfunction:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Age: 65 and older
• Medical conditions:
  
  • Diabetes
  • Arteriosclerosis (hardening of arteries)
  • Chronic kidney disease
  • Liver failure
  • Peyronie's disease (bending of the penis caused by scar tissue)
  • Endocrine disorders
  • Neurological disorders (ie, multiple sclerosis , peripheral neuropathy , stroke )
  • Hypertension
  • Psychiatric disorders (ie, anxiety , depression )
• Traumatic conditions:
  
  • Vascular surgery
  • Pelvic surgeries (particularly for prostate cancer )
  • Spinal cord injury
• Behaviors:
  
  • Alcohol use
  • Illegal drug use
  • Anabolic steroid use
  • Heavy smoking
  • Interpersonal conflicts with a sexual partner
• Medications:
  
  • Antihypertensives
  • Antihistamines
  • Antidepressants
  • Tranquilizers
  • Antipsychotics

Symptoms

Symptoms include:

• A less firm penis
• Fewer erections

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological or physical factors are causing your impotence.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, the doctor may order laboratory tests. These laboratory tests will include hormone levels such as thyroid function tests, prolactin levels, and testosterone levels.

Treatment

Treatment options include:

Prevention

To reduce your chance of becoming impotent:

• Take medications to manage blood pressure, diabetes, or depression.
• If medications may be the problem, ask your doctor about changing the medication or adjusting the regimen.
• Maintain a healthful lifestyle and diet.
• Do not smoke. Smoking is significantly associated with erectile dysfunction in middle-aged and older men.
• Try ongoing communication and relationship counseling to prevent or manage interpersonal conflict.