(ED; Erectile Dysfunction; Male Erectile Disorder)
Impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.
To initiate and maintain an erection, the penis must fill with blood. One type of blood vessel opens wide to allow blood into the penis. Meanwhile, a second type of blood vessel squeezes down to keep the blood from leaving the penis. Nerve signals cause the proper changes in the blood vessels.
The following factors can cause erectile dysfunction:
The blood vessels that keep the blood from leaving the penis may be injured or have disease. This can cause a leak in these vessels. Blood can escape through these leaks during an erection. This means that an erection cannot occur or may not last long.
Problems with the nerves and blood vessels can cause impotence. Conditions that can cause problems include:
- Nerve dysfunction—can reduce feeling in the penis, resulting in impotence
- Diabetes —interferes with nerve signals
- Hardening of the arteries —can cause reduced blood flow
- Peripheral neuropathy, spinal cord injury, and surgery—can damage nerves
- Side-effects from medications—interferes with proper functioning of the blood vessels
Blood Vessels and Nerves of the Male Pelvis
Impotence is more common in men who are 65 and older. It is also more common in men of Hispanic descent.
Factors that increase your chance of developing impotence include:
Certain medical conditions:
- Arteriosclerosis—hardening of the arteries
- Chronic kidney disease
- Liver failure
- Endocrine disorders
- Peyronie's disease—bending of the penis caused by scar tissue
- Neurological disorders such as multiple sclerosis, peripheral neuropathy, and stroke
- High blood pressure
- Psychiatric disorders, such as anxiety and depression
- Vascular surgery
- Pelvic surgeries, particularly for prostate cancer
- Spinal cord injury
- Antihypertensives—for high blood pressure
- Antihistamines—common as allergy medication
- A less firm penis
- Fewer erections
You will be asked about your symptoms and medical history. A physical exam will be done. Expect questions about the frequency, quality, and duration of your erections. Your answers may help the diagnosis.
Your bodily fluids may be tested. This can be done with blood tests.
Nocturnal Penile Tumescence Testing
This test will monitor erections while you sleep. Involuntary erections during sleep are normal. If you have impotence but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical.
Doppler imaging is used to look at the blood flow. The test is done to check for blood flow in the penis. It will also look for blockage in the arteries or veins that supply the penis.
Treatment options include:
Your doctor may prescribe:
Do not take these medications if you are also taking nitrates.
- Oral testosterone , if you have low testosterone levels
- Alprostadil , either injected into the penis or inserted into the urethra as a suppository
Use caution and talk to your doctor before taking any over-the-counter medications for impotence. Some of them may be unsafe.
A vacuum device pulls blood into the penis. A band will then be placed around the penis to keep the erection. A vacuum device may include:
- Plastic cylinder for the penis
- Hand pump for pumping air out of the cylinder
- Elastic band for holding the erection after removal of the cylinder
Vascular surgery is done to repair the blood vessel leaks. This has been shown to be effective in some cases.
Implants may be placed in the penis. The implants can be inflated to simulate an erection.
To reduce your chance of becoming impotent:
- Follow treatment plans to manage blood pressure, diabetes, or depression.
- Maintain a healthy weight .
- Eat a healthful diet .
- If you smoke, talk to your doctor about ways to quit . Smoking is significantly associated with impotence in older men.
Family Doctor—American Academy of Family Physicians
Urology Care Foundation
Canadian Urological Association
SexualityandU—Society of Obstetricians and Gynaecologists of Canada
Erectile dysfunction. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113875/Erectile-dysfunction. Updated February 29, 2016. Accessed September 28, 2016.
Erectile dysfunction. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/ED/index.aspx. Updated March 28, 2012. Accessed August 17, 2015.
Erectile dysfunction. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/erectile-dysfunction. Accessed August 17, 2015.
Viera A, Shenenberger D, Green G. Am Fam Physician. 1999 Sep 15;60(4):1159-66. Available at: http://www.aafp.org/afp/1999/0915/p1159.html. Accessed August 17, 2015.
Last reviewed August 2015 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.