• Defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.
• Also known as impotence
• It was estimated that, in 1995, over 152 million men worldwide experienced ED.
• For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide.
• In fact more than 50% of men between the ages of 40 and 70 experience some form of ED
• In the past, erectile dysfunction was commonly believed to be caused by psychological problems.
• It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.
• Many advances have occurred in both diagnosis and treatment of erectile dysfunction.
• Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health, such as directly asking them about their sexual function through conversation or a questionnaire during a check-up
• In this way doctors may be able to detect more serious health conditions sooner.
• According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases

Direct risk factors

• Prostate problems
• Type 2 diabetes
• Hypogonadism
• Hypertension / high blood pressure
• Vascular disease and vascular surgery
• High blood cholesterol
• Low levels of HDL / high-density lipoprotein
• Chronic sleep disorders – obstructive sleep apnoea, insomnia
• Prescription drugs
• Neurogenic disorders
• Peyronie’s disease – distortion or curvature of the penis
• Priapism – inflammation of the penis
• Depression
• Alcohol use
• Lack of sexual knowledge
• Poor sexual techniques
• Inadequate interpersonal relationships
• Many chronic diseases, especially renal failure and dialysis
• Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension

Indirect risk factor

• Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Different types (and causes) of ED

Organic ED

• Abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men.
• When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause.
• Risk factors for arteriosclerosis
• being overweight
• lack of exercise
• high cholesterol
• high blood pressure,
• cigarette smoking
• These factors can cause erectile failure often before progressing to affect the heart.
• Partial or complete wasting or excess smooth muscle tissue around the veins in the body of the penis triggers problems with being able to maintain a firm erection and or losing an erection too quickly
• This is also believed to be an early manifestation of atherosclerosis and vascular disease.

Diabetes ED

• Common in people with diabetes.
• An estimated 2.5 million adult men in the UK have diabetes, of which 35 to 75% struggle with ED.
• Diabetes involves premature and unusually severe hardening of the arteries.
• Peripheral neuropathy, involving the nerves controlling erections, is commonly seen in people with diabetes.

Neurologic ED

• Diabetes
• Chronic alcoholism
• Multiple sclerosis
• Heavy metal poisoning
• Spinal cord and nerve injuries
• Nerve damage from pelvic operations.

Drug-induced ED

• A great variety of prescription drugs, such as

– blood pressure medications

– antianxiety medication

– antidepressants

– glaucoma eye drops

– cancer chemotherapy agents

and many more.

Hormone-induced ED

• Hormonal abnormalities, such as

– increased prolactin

– steroid abuse by bodybuilders

– too much or too little thyroid hormone

– hormones administered for prostate cancer

– low testosterone can contribute to ED but is rarely the sole factor responsible for ED.

Psychogenic ED

• Performance anxiety – often caused by stress
• Depression

Diagnosing ED

• Patient medical and sexual history

– reveal conditions or diseases that lead to impotence

– distinguish among problems with erection, ejaculation, orgasm, and or sexual desire.

• Physical examination

– problem in the nervous system – penis does not respond as expected to touch

– Secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involve the endocrine system.

– Circulatory problems

– Unusual characteristics of the penis itself could suggest the basis of the impotence.

• Laboratory tests

– blood counts

– urinalysis

– lipid profile

– measurements of creatinine and liver enzymes

– measurement of testosterone in the blood is often done in men with ED, especially with a history of decreased libido or diabetes.

• Psychosocial examination

– revealing psychological factors that may be affecting performance.

– the sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse.