Erectile dysfunction (ED), or impotence, is the inability to get or keep an erection (hard penis) for enough time to have satisfactory sex. To get and maintain an erection, blood must be able to flow into and stay in the penis. Men commonly have problems with their erections once in a while. But if ED occurs frequently, medical therapy may be helpful. About 30 million men in the United States have ED. It can happen at any age, but is more common in men older than 65. ED is treatable at any age. ED can be a symptom of early blood vessel disease in other locations in the body.
The evaluation of ED starts with a careful medical history, including history of sexual function, medications, illnesses, or injuries that could cause ED; and any recent physical or emotional changes. The evaluation typically includes a physical exam, urinalysis, and a measurement of early morning testosterone levels. The doctor may also order blood tests for luteinizing hormone (LH), follicle stimulating hormone (FSH), the hormone prolactin, fasting blood glucose (sugar), and lipids (blood fats such as cholesterol). To obtain more information about patient man’s general and endocrine (hormonal) function, the doctor may also test for liver, kidney, and thyroid disorders.
Causes of erectile dysfunction
Any physical condition that interferes with sexual desire (libido), blood flow, or nerve signals to the penis can cause ED. The most common causes are conditions that affect blood vessels and blood flow in the penis, such as hardening of the arteries (atherosclerosis) that is linked to diabetes, obesity, smoking, high blood pressure, and high cholesterol. Medications (antidepressants, sleeping pills or tranquilizers, and drugs to treat high blood pressure, pain, or prostate cancer), alcohol, tobacco, and illegal drugs commonly cause ED.
Other common causes for ED include:
Brain diseases (such as stroke)
Damage to the nerves that deliver signals from the brain and spinal cord to the penis due to diabetes, multiple sclerosis, spinal cord injuries, pelvic or prostate surgery, radiation therapy, or pelvic or bicycle seat pressure trauma
Hormone imbalances such as low testosterone, high prolactin, and abnormal thyroid hormone levels
Chronic kidney and liver disease, which affect blood vessels, nerves, and hormone levels
Rarely, scarring of the penis that causes a severe curving (Peyronie’s disease) during erections