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Erectile dysfunction (ED), previously known as “impotence,” is a medical condition that affects millions of men worldwide. It impacts self-confidence and can have devastating effects on relationships. As recently as 10 years ago, the medical community thought that the cause of ED was primarily psychological. Today we know this is not exactly true, with many cases caused by physical conditions, including heart disease and diabetes.
What is erectile dysfunction?
In 1992, the National Institute of Health defined the term “erectile dysfunction” as the consistent inability to attain and maintain an erection sufficient for sexual intercourse. This new definition replaced “impotence” to describe the inability of the male to achieve an erect penis as part of the overall multi-faceted process of male sexual function. The former term was not only medically inaccurate, it also carried a negative connotation. It implied a lack of power, and suggested weakness and inadequacy. In fact, Webster’s Dictionary defines impotence as both “incapable of sexual intercourse” and “having no power: ineffectual.” Little surprise then, that a stigma surrounding impotence evolved.
How many men are affected by ED?
ED has been called the most common sexual disorder among men. As many as three million Canadian men experience erectile dysfunction.
Worldwide, ED affects an estimated 152 million men. Projections for 2025 show an increase of nearly 170 million men with ED.
Causes and Etiology of ED
Most men experience occasional ED at some time in their lives, which is natural and no cause for concern. However, when ED persists, medical expertise should be sought. There are many causes of ED, including vascular, hormonal, neurological, psychological and chronic diseases. Whatever the cause, the result is the same: an inability to acquire or maintain an erection sufficient for sexual intercourse. Discovering the origin of the problem is key to effective treatment.
Vascular:
The most common cause of ED is vascular, accounting for 40 per cent of ED patients. An erection is achieved by blood coursing into and becoming trapped in the penis. However, if the vessels are clogged or blocked, blood can’t enter the penis to produce an erection.
Factors that contribute to vascular obstruction include hypertension (high blood pressure), coronary artery disease, smoking, alcoholism and diabetes.
Hormonal:
An imbalance of hormones, such as testosterone, thyroid or prolactin (a pituitary hormone that stimulates and maintains the secretion of milk) can result in ED.
Neurological:
Brain injury caused by stroke, multiple sclerosis, Parkinson’s disease, or trauma can affect the source of the signals that govern erections. Back, prostate or bladder surgery may also damage the neural connection of the penis to the erectile centres of the brain and spinal cord.
Chronic Disease:
ED is three times more common in men with diabetes than in the general population, affecting 25 to 75 per cent of men with the disease. ED occurs in nine per cent of men with diabetes between age 20 to 29 years and rising to 95 per cent by age 70.
Alcoholism/Smoking:
Those who smoke more than one pack per day have a 50 per cent higher risk of ED than non-smokers of the same age. Alcohol or recreational drugs also impede blood supply to the penis.
Trauma:
Physical damage to the penile tissue itself can result in an inability to effectively contain the blood necessary for erection. This includes acute or chronic low-grade trauma to the nerves and pelvis.
Pharmacological:
More than 200 different medications may cause ED, and as many as 25 per cent of ED cases are caused by the side effects of medication, affecting libido, erectile function and ejaculatory mechanisms. Such medications may include certain antihypertensive drugs, beta blockers, diuretics, antipsychotic and antidepressant medications.
Aging:
A myth exists that aging inevitably leads to ED. This is simply not true. A healthy and robust man of ninety can enjoy an active sex life. In fact, it is not normal for a man to completely lose erectile function based solely on the aging process. It is true, though, that age does affect the ability to achieve an erection to some degree. Older men may take longer to acquire an erection or need more direct stimulation. However, because there is a direct correlation between age and disorders that cause ED, such as hypertension or atherosclerosis (hardening of the arteries), it is mistakenly assumed that age alone is the reason for ED.
Psychological:
While many cases of ED originate from physiological disorders, psychological distress can also be an underlying cause. Anxiety, depression, stress, chronic pain or guilt can all hamper sexual arousal. Any of these emotions can cause the release of adrenaline, reducing blood supply to the penis.
How is ED diagnosed?
Detecting the root cause of the patient’s dysfunction requires comprehensive questions and evaluative tests. Typically, a patient will be asked about his medical and sexual history. Following this, a physical examination may be performed and a blood sample may be obtained. Some physicians advocate including an ultrasound examination of the penis to assess arterial blood flow.
What is erectile dysfunction?
In 1992, the National Institute of Health defined the term “erectile dysfunction” as the consistent inability to attain and maintain an erection sufficient for sexual intercourse. This new definition replaced “impotence” to describe the inability of the male to achieve an erect penis as part of the overall multi-faceted process of male sexual function. The former term was not only medically inaccurate, it also carried a negative connotation. It implied a lack of power, and suggested weakness and inadequacy. In fact, Webster’s Dictionary defines impotence as both “incapable of sexual intercourse” and “having no power: ineffectual.” Little surprise then, that a stigma surrounding impotence evolved.
How many men are affected by ED?
ED has been called the most common sexual disorder among men. As many as three million Canadian men experience erectile dysfunction.
Worldwide, ED affects an estimated 152 million men. Projections for 2025 show an increase of nearly 170 million men with ED.
Causes and Etiology of ED
Most men experience occasional ED at some time in their lives, which is natural and no cause for concern. However, when ED persists, medical expertise should be sought. There are many causes of ED, including vascular, hormonal, neurological, psychological and chronic diseases. Whatever the cause, the result is the same: an inability to acquire or maintain an erection sufficient for sexual intercourse. Discovering the origin of the problem is key to effective treatment.
Vascular:
The most common cause of ED is vascular, accounting for 40 per cent of ED patients. An erection is achieved by blood coursing into and becoming trapped in the penis. However, if the vessels are clogged or blocked, blood can’t enter the penis to produce an erection.
Factors that contribute to vascular obstruction include hypertension (high blood pressure), coronary artery disease, smoking, alcoholism and diabetes.
Hormonal:
An imbalance of hormones, such as testosterone, thyroid or prolactin (a pituitary hormone that stimulates and maintains the secretion of milk) can result in ED.
Neurological:
Brain injury caused by stroke, multiple sclerosis, Parkinson’s disease, or trauma can affect the source of the signals that govern erections. Back, prostate or bladder surgery may also damage the neural connection of the penis to the erectile centres of the brain and spinal cord.
Chronic Disease:
ED is three times more common in men with diabetes than in the general population, affecting 25 to 75 per cent of men with the disease. ED occurs in nine per cent of men with diabetes between age 20 to 29 years and rising to 95 per cent by age 70.
Alcoholism/Smoking:
Those who smoke more than one pack per day have a 50 per cent higher risk of ED than non-smokers of the same age. Alcohol or recreational drugs also impede blood supply to the penis.
Trauma:
Physical damage to the penile tissue itself can result in an inability to effectively contain the blood necessary for erection. This includes acute or chronic low-grade trauma to the nerves and pelvis.
Pharmacological:
More than 200 different medications may cause ED, and as many as 25 per cent of ED cases are caused by the side effects of medication, affecting libido, erectile function and ejaculatory mechanisms. Such medications may include certain antihypertensive drugs, beta blockers, diuretics, antipsychotic and antidepressant medications.
Aging:
A myth exists that aging inevitably leads to ED. This is simply not true. A healthy and robust man of ninety can enjoy an active sex life. In fact, it is not normal for a man to completely lose erectile function based solely on the aging process. It is true, though, that age does affect the ability to achieve an erection to some degree. Older men may take longer to acquire an erection or need more direct stimulation. However, because there is a direct correlation between age and disorders that cause ED, such as hypertension or atherosclerosis (hardening of the arteries), it is mistakenly assumed that age alone is the reason for ED.
Psychological:
While many cases of ED originate from physiological disorders, psychological distress can also be an underlying cause. Anxiety, depression, stress, chronic pain or guilt can all hamper sexual arousal. Any of these emotions can cause the release of adrenaline, reducing blood supply to the penis.
How is ED diagnosed?
Detecting the root cause of the patient’s dysfunction requires comprehensive questions and evaluative tests. Typically, a patient will be asked about his medical and sexual history. Following this, a physical examination may be performed and a blood sample may be obtained. Some physicians advocate including an ultrasound examination of the penis to assess arterial blood flow.