Erectile Dysfunction (Impotence) Quiz: Causes & Treatment

Erectile dysfunction (ED) is the inability to achieve or maintain an erection firm enough for sexual activity. ED, also referred to as impotence, may involve the total inability to achieve an erection, or only brief erections, or not being able to reliably get an erection.

Causes of ED may include diabetes, high blood pressure, heart disease, nerve disease or nerve damage, multiple sclerosis, or hardening of the arteries (atherosclerosis). Treatment for ED depends on the cause.

Achieving an erection is a complex process that involves signals from the brain, the male sex hormone testosterone, a functioning nervous system, and healthy vascular tissue in the penis. Erectile dysfunction can be caused by factors that are medical, physical, or psychological. This can include three main problems:
- Insufficient blood flow to the penis
- Inability to store blood in the penis during an erection
- Nerve signals from the brain or spinal cord do not reach the penis.

Other factors that could influence ED include medicine, alcohol, or drugs.

While erectile dysfunction is more common as men age, aging itself is not the cause of ED. Most cases of ED have a physical cause, and ED can also be a warning sign of a more serious illness including heart disease, high blood pressure, or diabetes. Often treating the underlying condition can restore erectile function.

About 30 million men in the U.S. are affected by erectile dysfunction. Most men have difficulty getting or maintaining an erection on occasion, but some men have the problem more frequently or severely. In these men, ED can impact marriage and intimate relationships, it can cause low self-esteem, performance anxiety, depression, and stress.

Erectile dysfunction is not inherited and is not caused by genetic risk factors. Risk factors for developing ED include:
- age over 50
- diabetes
- high blood pressure
- high cholesterol
- smoking
- cardiovascular disease
- excessive alcohol use
- being overweight
- lack of physical activity

The most popular treatments for erectile dysfunction include oral medications that help increase blood flow to the penis resulting in a more rigid or longer-lasting erection. These drugs include sildenafil citrate (Viagra^®), vardenafil HCl (Levitra^®), and tadalafil (Cialis^®).

For patients who cannot tolerate the oral medications, alprostadil (Caverject^®, Edex^®, Muse^®) is another drug that comes in two forms, one where the patient injects it directly into the side of the penis, or as a suppository inserted into the urethra at the tip of the penis.

For men who cannot or do not wish to take medications, external vacuum pumps are available, which help draw blood into the erectile tissue, resulting in an erection.

Many different types of medications can cause erectile dysfunction as a side effect. High blood pressure medications can cause ED as a side effect. Drugs of abuse such as marijuana, heroin, and cocaine, along with alcohol can also result in ED.

Other causes of ED include surgery, depression, anxiety, stress, marital problems, and performance anxiety.

A potential complication of surgery to remove prostate cancer (radical prostatectomy) includes erectile dysfunction. A newer technique called nerve-sparing radical prostatectomy can offer results in recovery of erectile function over time.

Low testosterone (low T) can cause erectile dysfunction, but ED does not cause low T. In addition to ED, other sexual symptoms of low T include reduced sexual desire (libido), and reduced sexual activity. Nonsexual symptoms include increased body fat, reduced muscle mass, fatigue, and depression.

Erectile dysfunction can be an early warning sign for heart disease or other vascular problems. Atherosclerosis (hardening of the arteries) in the arteries supplying the penis can inhibit blood flow needed to begin or maintain an erection.

Surgery is another treatment option in some cases of erectile dysfunction. Surgical intervention is aimed at repairing arteries to restore blood flow to the penis that may be cause by a blockage or leakage. Surgery for ED may involve:
- Repair of leaking veins that prevent maintaining an erection
- Bypassing blocked arteries to re-route blood to the penis
- Blocking veins that take blood away from the penis