Erectile dysfunction (impotence)
Erectile dysfunction (ED), also known as impotence, is the inability to have a hard erection initially and/or to have a hard erection that lasts long enough for sexual activity.
Symptoms of erectile dysfunction include lack of an erection hard enough for penetration and/or lasting long enough for completion of sexual activity.
ED may occur with or without other sexual dysfunction, including decreased libido (decreased interest in sexual activity), orgasmic dysfunction (troubles achieving an orgasm/climax), and ejaculatory dysfunction.
Erectile dysfunction is common, and the risk of developing ED increases with age. The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis (hardening of the arteries), depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance (drug) abuse, pelvic surgery including radical prostatectomy, pelvic radiation, penile/perineal/pelvic trauma such as pelvic fracture, Peyronie’s disease (a disorder that causes curvature of the penis and sometimes painful erections), and low testosterone levels.
What is normal penis anatomy?
The penis contains two cylinders, called the corpora cavernosa, which are on the top of the penis (see figure 1 below). These two cylinders are involved in erections. The urethra, the tube that the urine and ejaculate passes through, runs along the underside of the penis and is surrounded by tissue known as the corpus spongiosum. The corpora cavernosa are made up of spongy tissue that has muscles, fibrous tissues, veins, and arteries within it. The inside of the corpora cavernosa is like a sponge, with potential spaces that can fill with blood and distend. A layer of tissue that is like Saran Wrap, called the tunica albuginea, surrounds the corpora. Veins located just under the tunica albuginea drain blood out of the penis.
What causes ED?
There are many possible causes for ED, and they can include both emotional and physical disorders. Some common causes are:
- cardiovascular disease
- damage from cancer or surgery
- obesity or being overweight
- increased age
- relationship problems
- drug use
- alcohol use
ED can be caused by only one of these factors or several. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions.
How does age affect incidence of ED?
Up to 30 million American men are affected by ED, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The prevalence of ED increases with age. ED affects:
12 percent of men younger than 60
22 percent of men in their 60s
30 percent of men 70 or older
Although the risk of ED increases with age, ED is not inevitable as you get older. It may be more difficult to get an erection as you age, but that doesn’t necessarily mean you will develop ED. In general, the healthier you are, the better your sexual function.
How is ED diagnosed?
Your doctor will ask you questions about your symptoms and health history. They may do tests to determine if your symptoms are caused by an underlying condition. You should expect a physical exam where your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostate. Additionally, you may need blood or urine tests to rule out other conditions.
What treatments are available?
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