Impotence

Causes of erectile dysfunction

Erectile dysfunction can be caused by either physical problems or psychological problems, or a combination of the two. The most common risk factors for erectile dysfunction include:

• Alcohol abuse
• Chronic diseases, such as kidney failure
• Complications from diabetes
• Depression, anxiety and stress
• Heart disease and heart failure
• High blood pressure
• Hormone imbalance
• Lack of exercise and being overweight
• Low levels of HDL (high-density lipoprotein)
• Medication side-effects
• Neurologic problems, such as multiple sclerosis or nerve injury
• Performance anxiety
• Peyronie's disease (curvature of the penis)
• Prostate problems
• Relationship problems and lack of interest
• Smoking
• Vascular disease

Age-related health problems might also cause erectile dysfunction, including the hardening of arteries and injury, or leaks in the veins of the penis. This is called organic erectile dysfunction because it happens naturally with age.

Diagnosis and testing of erectile dysfunction

The main symptom of erectile dysfunction is trouble getting or keeping an erection that is firm enough to have sexual intercourse. It may not happen every time you have sex, but if you're unable to get an erection and keep it each time you have sex, you should be evaluated for erectile dysfunction.

Your doctor can diagnose erectile dysfunction based on:

• Lab tests – This may require a urine sample and blood work to measure cholesterol, creatinine and liver enzymes. Your testosterone levels may also be checked because it could indicate problems with your endocrine system.
• Medical and sexual history – Your doctor may ask about problems with erection, ejaculation, orgasm and sexual desire.
• Physical exam – Your doctor will check for physical problems with the penis, as well as any other conditions, such as an endocrine problem, that may be causing erectile dysfunction.

If no physical problem can be found, your doctor may recommend a psychosocial exam to learn about any psychological problems that may be causing erectile dysfunction, such as stress or performance anxiety.

Erectile dysfunction treatment options

In most cases, erectile dysfunction can be treated. Depending on your symptoms and the cause of your erectile dysfunction, your doctor may suggest one of the following treatment options, or a combination:

• Changing your prescription medications
• Implants, either inflatable or formed, to cause the penis to be erect when other treatments don't work
• Lifestyle changes, such as quitting smoking or starting to exercise
• Medicine to help you get and keep an erection, either taken by mouth or injected
• Psychotherapy
• Testosterone therapy, for men with low levels
• Vacuum devices, to draw blood into the penis and cause an erection

You don't have to suffer in silence. Talk to your doctor about diagnosis and treatment for erectile dysfunction.