| Erectile dysfunction | |
|---|---|
| Other names | Impotence |
| Specialty | Urology, sexual medicine, andrology |
| Symptoms | Inability to gain or maintain an erection |
| Causes | Low testosterone levels,[1][2] certain prescription drugs,[3][4] neurogenic disorders[3][4][5][2] |
| Risk factors | Cardiovascular disease, diabetes, smoking, stress,[6] mental disorders,[6] ageing,[1] high saturated fat diet,[7][8] kidney disease[9] |
| Diagnostic method | Depends if psychological or physiological; absence of involuntary erections suggests physiological[4] |
| Differential diagnosis | Hypogonadism,[4] prolactinoma[4] |
| Prevention | Adequate exercise[10] |
| Treatment | Penis pump,[11] counseling (psychological treatment)[12] |
| Medication | Sildenafil, Tadalafil, Vardenafil[13] |
Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.
The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions like depression, stress, and problems within relationships.[14]
The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.
Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues.[4] In many instances, medication-based therapies are used, specifically PDE5 inhibitors like sildenafil.[13] These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.[4][15]
ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.[14]
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