Erectile dysfunction (ED), or male impotence, is a man’s inability to get or keep an erection long enough to finish sexual activity. ED causes great distress and problems with relationships.
The percentage of men affected with ED increases with age. About 10% of men in their 60s and 30% in their 70s have ED.
Causes are both physical and psychological (psychogenic). Most older men with ED have heart and blood vessel disease. Other causes are medicines, nervous system problems, hormone deficiency, diabetes, hypertension, and smoking. Psychogenic ED, a result of emotional problems, is much more common and harder to diagnose.
The main symptom is inability to get or keep an erection until the end of sexual activity.
If the cause is psychological, men may have associated anxiety, mood swings, depression, insomnia, and concerns about sexual performance.
If the cause is physical, symptoms of medical illness may include poor circulation in the legs, chest pains, or shortness of breath with exercise (possible heart disease). Diabetes is frequently associated with ED.
The health care provider will ask about the firmness and duration of erections at different times (e.g., sex with partners, erections after sleep). Discussing sexual dysfunction with a health care provider is very important because many conditions causing it can be successfully treated. If a man has no diseases that cause ED and can have an erection with masturbation or early morning awakening, he likely has ED due to psychological causes.
The basic treatment for performance anxiety is to ask the man to make love with his partner without trying intercourse, to show him and the partner how lovemaking can feel without a concern with failure. This method (called sensate focus) lets the man have a different focus: pleasing his partner and himself.
Men with physical causes of ED have options, including such medicines as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®). Men who use nitroglycerin products and those who should avoid sexual activity because of cardiovascular disease shouldn’t take these drugs. Other treatment modalities include use of a vacuum pump or injection of a substance (papaverine) into the penis to increase blood flow to the penis. Men can also have surgery to put a prosthesis into the penis.
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