Erectile dysfunction, also called impotence, is the inability to attain or maintain an erection of the penis that is firm enough for penetration during sexual intercourse. 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.

Causes of Erectile Dysfunction

  • Venous Leak: If the blood vessels (veins) which normally compress during an erection do not fully compress, an erection may not be attainable or may not last long. This can be caused by injury or diseases which prevent the full expansion of the vessels (arteries) which normally expand with blood.
  • Neurovascular Function: Erection cannot be attained if nerve signals do not prompt blood vessels to do their job or if blood flow to the penis is reduced. Nerve dysfunction can also diminish feeling in the penis, resulting in impotence. Many medications can cause erectile dysfunction by impairing either vascular or nerve function. Medical conditions that can lead to neurovascular dysfunction include:
  1. Diabetes: can interfere with nerve signals
  2. Arteriosclerosis(hardening of the arteries): can reduce blood flow
  3. Peripheral neuropathy, spinal cord injury, and surgery: can damage nerves
  • Psychological Factors: Psychological factors account for 10%-15%of erectile dysfunction cases. The brain initiates many of the nerve signals required for a successful erection. Problems in your relationship, feelings of guilt associated with sex, depression, anxiety, and stress can all lead to erectile dysfunction. Recent estimates suggest that roughly 20 million US men have erectile dysfunction. Erectile dysfunction increases with age, from about 5% at age 40, to 15%-25% at age 65 and older.

Risk Factors for Erectile Dysfunction

A risk factor is something that increases your likelihood of getting a disease or condition.  It is possible to develop erectile dysfunction with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing erectile dysfunction. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk. Risk factors include:

  • Age:
  1.  The incidence of erectile dysfunction rises with age.
  2. One in four for men in their 60s
  3. Nine in ten for men in their 80s
  • Medical Conditions: Certain medical conditions can increase your risk of erectile dysfunction, including:
  1. Diabetes
  2. Cardiovascular disease
  3. Arteriosclerosis(hardening of arteries)
  4. Chronic kidney disease·        Cirrhosis
  5. Chronic obstructive pulmonary disease(COPD)
  6. Pyronine’s disease(bending of the penis caused by scar tissue)
  7. Endocrine disorders (hypogonadism, hyperthyroidism, hypothyroidism, hyperprolactinemia, Cushing’s syndrome)·
  8. Neurological disorders(such as multiple sclerosis, peripheral neuropathy, stroke)
  9. Myotonic dystrophy
  10. Hypertension (high blood pressure)
  11. Psychiatric disorders(such as anxiety, depression, schizophrenia)
  12. Psychological problems (stress, personal relationships, new partners)
  • Traumatic Conditions: Trauma, whether through an accident or surgery, can increase your risk of erectile dysfunction. Trauma includes:
  1. Vascular surgery
  2. Urologic surgery, such as prostate surgery
  3. Pelvic surgeries (particularly for prostate cancer)
  4. Spinal cord injury
  • Behaviors:  Certain behaviours can increase your risk of erectile dysfunction, including:
  1. Alcohol use
  2. Illegal drug use (e.g., heroin, marijuana)
  3. Anabolic steroid use
  4. Heavy smoking
  • Medications:  Certain medications can increase your risk of erectile dysfunction, including:
  1. Antihypertensives
  2. Antihistamines
  3. Antidepressants
  4. Tranquilizers
  5. Antipsychotics
  6. Histamine blockers
  7. Nicotine

If you suspect a medication may be affecting your sexual functioning, talk with your doctor. Do not stop taking a medication without talking to your doctor first.

Reducing Your Risk of Erectile Dysfunction

A risk factor increases your chance of getting a disease. Some risk factors can be avoided, such as smoking. Other risk factors you may have no control over, such as your genetic make-up. If you have a risk factor for erectile dysfunction that you can and do change, you may reduce your risk.

To reduce your risk of becoming impotent:

  • Manage your medical conditions.
  • Talk to your doctor about changing medications.
  • Maintain a healthful diet and exercise program.
  • Quit smoking.
  • Do not use recreational drugs.
  • Consider counselling.

1. Manage Medical Conditions:  Some cases of erectile dysfunction are due to chronic diseases of the lungs, liver, kidneys, heart, nerves, arteries, or veins. With your physician’s help, you can manage conditions that could affect your ability to have an erection, such as high blood pressure, diabetes, cardiovascular disease, and depression.

2. Talk to Your Doctor About Medications:  If you suspect that your medications may be the problem, ask your doctor about changing or adjusting them. Medications for the following conditions are most commonly associated with erectile dysfunction as a side effect:

  • High blood pressure
  • Depression
  • Anxiety
  • Schizophrenia

3. Maintain a Healthful Diet and Exercise Program: Eat a healthful diet, one that is low in saturated fat and high in fruits, vegetables, and whole grains. Begin and stick to a regular exercise plan.Choose exercises you enjoy and will make a regular part of your day. Strive to maintain an exercise program that keeps you fit and at a healthy weight. For many people, this includes walking or participating in an aerobic activity for30 minutes per day. Exercise also can help you manage stress. Check with your doctor before starting any exercise program.

4. Quit Smoking:  Excessive tobacco use can also damage penile arteries. Quitting smoking reduces your risk of erectile dysfunction.

5. Do Not Use Recreational Drugs: Chronic use of alcohol, marijuana, or other drugs, like cocaine, speed, or heroin, often causes erectile dysfunction, along with the decreased sexual drive.

6. Consider Counseling:  Psychological factors, such as stress, anxiety, and depression, account for 10%-5% of erectile dysfunction cases. Counseling can help you manage or prevent these emotions and interpersonal conflict. You may also want to try couples counseling.

7. Special Considerations:  Before quitting any medications, and even alcohol or tobacco if you are addicted, consult with your doctor about the safest way to do it.

Symptoms of Erectile Dysfunction

Penile erection is a complex interaction of both halves of your autonomic (automatic) nervous system, your blood circulation, and your emotions.Therefore, the patient may have symptoms suggestive of a psychological problem, such as depression, and/or a medical problem, such as diabetes. Any of these conditions can lead to erectile dysfunction.

Symptoms include:

  • A less firm penis
  • Fewer erections
  • Fewer spontaneous nighttime erections

Your penis is made up of cylinders with tough linings. These linings can hold large amounts of blood at sufficient pressure to keep it stiff for a period of time. Normally, when stimulated either locally or from your emotions, blood vessels that empty your penis constrict. This prevents blood from exiting. Blood vessels inside your penis open to accept more blood.

Diagnosis of Erectile Dysfunction

The doctor will ask about your symptoms and medical history and will perform a physical exam. Be prepared to identify every medication you are taking. As many as 25% of erectile dysfunction cases are due to medications.

Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological and/or physiological factors are causing your impotence. The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, laboratory tests may be ordered. The following factors will be evaluated:

  • Routine Laboratory Tests —Blood count, urinalysis, and a battery of blood chemistry tests will evaluate your general health.
  • Testosterone —If you are over 50 years old or if your doctor suspects hypogonadism (small testes and reduced bodily hair), a blood test for testosterone will be ordered.
  • Endocrine Tests —Other endocrine tests may be ordered such as TSH, prolactin, and fasting blood sugar.
  • Nocturnal Erections —Potent men have spontaneous erections at night. If you do not remember them because you were asleep, there are devices that can measure and record them.
  • Psychology —There are always psychological factors associated with sexual functioning, whether they are the cause or just a result. You, and possibly your partner, may be given a questionnaire to help determine what emotional and psychological factors may be contributing to your condition.

 Treatments for Erectile Dysfunction

The treatment and management of erectile dysfunction may involve medicine, psychological counselling, lifestyle changes, surgery, and attention to other medical conditions that may be causing sexual dysfunction. The goal of treatment is to restore normal sexual function whenever possible and to discover alternatives to maintain or enhance the richness of your relationship.

Treatment may involve the following:

  • Lifestyle changes
  • Medications
  • Surgery
  • Other treatments
  • Medical treatments available for erectile dysfunction may include oral pills such as Viagra, Levitra, Cialis, urethral inserts, and injections.
  • Surgery is an option when all other efforts to restore or bypass your erectile dysfunction have failed. In fact, there are several possible alternatives that will permit you to have satisfactory sexual intercourse such as the penile implant.
  • Another treatment modality for erectile dysfunction is a vacuum constriction device, which involves a pump attached to an air-tight chamber that fits over your penis. This treatment, which can be used daily, is optimal for men who do not want or are not suitable for drug treatment. The blood is held there by a rubber-retaining ring around the base of your penis. The success rate is between 70%-94%.

Erectile dysfunction can cause male infertility because it interrupts or prevents intercourse. In order to conceive a child, sperm must be delivered to your partner's egg during intercourse. Thus, problems that prevent or interrupt intercourse, cause the inability to deliver sperm to the egg and lead to infertility. You probably don’t realize how many people have problems having sex. But sexual dysfunction is common: 43% of women and 31% of men report having at least one symptom. When a couple has an infertility issue, problems with their sexual relationship may become more pronounced because of the need to “perform” at specific times. Therefore, sexual activity may become an activity restricted for procreation rather than recreation. Because of this,sexual problems can arise.

Sexual Dysfunction and Infertility

  • What is sexual dysfunction?

Doctors divide normal sexual function into 3 phases: desire (you want to have sex), arousal (your body undergoes the physical changes that allow you to have sex), and orgasm. Sexual dysfunction occurs when your health, your relationship, or your ideas about sex cause problems in any of these phases. This is true for men and women. Pain during sex can also cause sexual dysfunction, especially for women.

  • Sexual dysfunction in men

The most common type of sexual problem in men is erectile dysfunction, which is when your penis does not become or stay firm. Many medical conditions can cause erectile dysfunction: high blood pressure, diabetes, blood vessel diseases, surgery that affects your bladder or genitals, nerve disease or injury, hormonal problems, depression. Certain medications can also cause erectile dysfunction. Another common sexual dysfunction in men is ejaculatory dysfunction, which occurs when a man does not release semen during orgasm.

  • Sexual dysfunction in women

Women with sexual dysfunction may have a low sexual desire, difficulty becoming aroused, or difficulty reaching orgasm. These disorders may be caused by many different physical or psychological problems. Women may feel pain during sex, which is called dyspareunia. Many things can cause dyspareunia, including diseases such as endometriosis or those that affect a woman's external genitals. Some women have a pain disorder called vaginismus, a condition in which the muscles around the vagina spasm and cause the vagina to close.

  • How do doctors diagnose and treat sexual dysfunction?

Your doctor will do a physical exam and ask you questions about your medical and sexual history. Important chemicals in your body, called hormones, affect your interest in and ability to have sex. Your doctor may measure your hormone levels, to make sure that they are not too high or too low. Your doctor will ask you what medications you are taking because some medications cause problems having sex. Once your doctor knows what is causing your sexual dysfunction, you may need treatment. Medications or surgery treat physical or medical problems. If the problem is psychological or it has to do with your relationship, your doctor may suggest that you and your partner talk to a sex therapist.

  • Sexual dysfunction and infertility

Sexual dysfunction may cause problems getting pregnant (infertility). But trying to get pregnant may also cause sexual dysfunction! A cause of infertility. If you are trying to get pregnant, you have to have sex at the right time. The right time for sexual activity is when the egg is released fromthe ovary (ovulation). Determining the time of ovulation by your partner’s menstrual history or by the use of a urine test that becomes positive when the hormone that triggers the egg to be released can be detected. If you cannot or do not have sex near that time, the woman is less likely to get pregnant. If you only have sex once in a while because of low sexual desire or pain during sex, you may miss that important time for pregnancy. Men who have erectile dysfunction or ejaculatory dysfunction will not be able to get their partner pregnant.

A consequence of infertility

Infertility treatments can be stressful,intrusive, and emotionally demanding. As part of your infertility treatments, you and your partner may need to have sex at certain times, even if you do not feel like it.Some of the medications that you need to take as part of your treatment may make it harder to have sex. All of these things can be bad for a couple’s sexual relationship and may lead to sexual dysfunction. Because of the stress caused by the need for a male to“ejaculate on demand,” some men may have erectile dysfunction. Both partners may have a less sexual desire. Because these problems are related to your infertility treatment, you definitely should talk to your fertility doctor about them.