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Since the discovery that the drug sildenafil (Viagra) - originally a heart drug - had an effect on men's penile erections, most people have become aware of erectile dysfunction as a medical condition.
Men who have a problem with their sexual performance may be reluctant to talk to their doctor, seeing it as an embarrassing issue. However, modern medicine has revealed numerous medical and psychological explanations for erectile dysfunction, including the possibility of serious underlying conditions that it is important to address.
A man is considered to have erectile dysfunction when he has regular difficulty in getting or maintaining a firm enough erection to be able to achieve sexual penetration, or which interferes with non-penetrative sexual activity.
Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm, but this is not normally cause for a diagnosis of erectile dysfunction. This condition is only considered a concern if satisfactory sexual performance has been impossible on a persistent number of occasions for some time.
Broadly, two forms of erectile dysfunction can affect men's sex lives - the main cause is either medical or psychosocial.
Medical conditions can also affect psychological wellbeing, meaning that, while the primary cause of sexual impotence is typically either medical or psychological, there is often overlap between the two.
Erectile dysfunction used to be known more widely as 'impotence' before the causes became better understood and successful treatments came into use. Impotence is a term that is still in use, however, although it can be seen as pejorative.
To understand the causes of erectile dysfunction, it helps to understand how an erection happens physically.
Relaxation of muscle (in parts of the penis and the walls of the arteries supplying it) allows blood to rush into the cylinder-shaped spongy tissue of the erection chambers, creating increased tissue pressure and an erection. Valves prevent the blood from flowing back out through the veins (which would cause a venous loss of pressure), and the resulting hardness persists until stimulation stops or ejaculation occurs.
This blood flow process is led by nervous and hormonal triggers activated when the brain is stimulated by touch or other stimuli; such brain signals can be suppressed by anxiety.
Normal erectile function can be affected by problems that compromise any of the following normal physiological contributions needed for an erect penis :
Physical causes of erectile dysfunction
It is always worth consulting a physician about persistent erection problems as the cause of erectile dysfunction could be any one of a number of serious medical conditions. Whether the cause is simple or serious, a proper diagnosis can help to address any underlying medical issues and can help resolve sexual difficulties.
Heart disease and narrowing of blood vessels
High blood pressure
Obesity and metabolic syndrome (which are also risk factors for diabetes)
Hormonal disorders including thyroid conditions and testosterone deficiency (hypogonadism)
Structural / anatomical disorder of the penis, such as Peyronie disease
Smoking, alcoholism and substance abuse, including cocaine use
Treatments for prostate disease
Surgical complications (surgeries include radical prostatectomy, cystectomy, trans-urethral resection of the prostate and rectal cancer surgery)
Injuries in the pelvic area or spinal cord
Radiation therapy to the pelvic region.
Psychological causes of erectile dysfunction
In rare cases, erectile dysfunction has always been present, with a man never having achieved an erection. This is called primary ED, with the cause almost always psychological if there is no obvious anatomical deformity or physiological issue that could be causative; such psychological factors can include:Ejaculatory disorders
Psychological factors are the cause of most cases of problems reaching climax - ejaculation occurring too soon, too late, or not at all. i.e. premature ejaculation and delayed ejaculation
Fear of intimacy
Keep your blood sugar in a safe range if you have diabetes.
Avoid excess alcohol intake and use of drugs.
Keep your cholesterol level low to reduce the risk of hardening of the arteries (atherosclerosis).
Lower stress in your life.
The best known treatments for erectile dysfunction are sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are group of drugs called PDE-5 (phosphodiesterase-5) inhibitors.
There is a range of potential adverse side-effects associated with PDE-5 inhibitors, including flushing, visual abnormalities, hearing loss, dyspepsia and headache.