An increasing number of men are suffering from a condition known as erectile dysfunction or impotence.
The percentage of men suffering from this condition is expected to continue to rise as the world’s population *increases in age.  This will present a challenge to researchers and healthcare providers as they will need to continue to explore more options for treating this disorder.
Overview Of Erectile Dysfunction
Erectile dysfunction (or impotence) is defined as the routine inability to achieve an erection, or to maintain an erection for the duration of time needed to achieve sexual satisfaction. 
Many men have this problem from time to time and it is generally nothing to worry about. However, if getting or maintaining an erection becomes a persistent problem, it’s always wise to seek medical treatment.
Erectile dysfunction is more prevalent in older men . Studies show that more than forty percent of men between the age of 40 and 70 experience erectile dysfunction. In men over 70 years of age, that percentage rises to nearly seventy percent.
While erectile dysfunction mainly affects older men, it’s a health problem that also affects younger men. Worldwide, in men younger than 40 years of age, erectile dysfunction is an issue that plagues between 1% and 30% of men. 
Studies have shown that though men of all races suffer from erectile dysfunction, this is a problem that occurs less often among black men and Asian men while white men are far more likely to have problems in this area. 
What Causes Erectile Dysfunction
As a function that involves everything from the blood vessels to the nerves and muscles as well as the emotions, hormones and brain, the arousal of males is an intricate process.
Any one of these systems can have an issue that will cause erectile dysfunction and there are a number of other things that can make the whole problem even worse.
Because all these systems work together, it can be a plethora of things that flow together creating erectile dysfunction. It’s not a simple matter.
Until recent times, most scientists and doctors thought that erectile dysfunction was the result of psychological problems in men. While there are important psychological elements that pertain to sexual function , we now know that psychological issues are not the root cause of erectile dysfunction for the majority of men.
Physical Contributors to Erectile Dysfunction
In most men, the cause of erectile dysfunction can be traced to something physical. These physical ailments, injuries, or diseases can cause problems with a man’s ability to achieve or maintain an erection. Some of the physical or organic problems that contribute to erectile dysfunction are:
- Obesity – In the majority of studies carried out, the findings have conclusively shown that men who are overweight or obese have much higher incidences of erectile dysfunction.  Studies have also indicated that when an obese man who suffers from erectile dysfunction *loses the weight that is causing the problem, they are able to *regain their sexual function. 
- Diabetes – When a person has diabetes, the nerves and blood vessels responsible for sexual arousal can become damaged by the effects of the disease. Men who live with diabetes are three times as likely as their non-diabetic counterparts to suffer from erectile dysfunction.  Frequently, men with diabetes will need more vigorous treatment to aid their erectile dysfunction. 
- Substance Abuse – The abuse of any substance can impair the brain. Illegal drugs, alcohol, cigarettes and recreational use of prescription medicine can all have an effect on the way the body operates. We’ll look at each of those in more detail now…
- Illegal Drugs – All recreational drugs can play a negative role in the processes and functions that lead to sexual arousal. Cocaine and amphetamines can narrow blood vessels which will prevent blood flow from getting to the penis. Heroin, barbiturates and other opioids decrease testosterone levels  which *reduces sexual desire. Marijuana may *increase sexual desire, but the side effects do not allow the smooth muscle in the penis to relax enough for proper blood flow to maintain an erection and if an erection is attained there will likely be difficulty in orgasming. 
- Smoking – Tobacco use is problematic for sexual health. The nicotine in cigarettes can decrease sexual desire while smoking itself damages the lining of blood vessels (endothelial tissue). This damage makes it difficult to obtain or sustain an erection. Smokers are at a much higher risk of developing erectile dysfunction than are non-smokers. 
- Alcohol – The use of alcohol has a large impact on all the bodily systems involved in creating an erection. Alcohol *lowers levels of hormones in your body including testosterone. Abuse of alcohol can result in many problems such as a decrease in sexual desire, difficulty in achieving an erection, difficulty reaching orgasm, or ejaculating prematurely. Up to 72% of men with alcohol dependence also suffer from erectile dysfunction. 
- Prescription Medication – Every prescription medication comes with a long list of possible side effects and, for a number of men, erectile dysfunction is one of the many they will experience. If you are on a prescription medication that is causing you to experience problems getting or keeping an erection, speak with your doctor. They can help you address the situation or recommend a different medication. There are over 200 prescription medications that list erectile dysfunction as a possible side effect. Just a few of these medicines are:
- Ulcer medication
- Prescription sedatives
- Blood pressure medication
- Appetite suppressants
- Cancer therapy medication
- Hormone Problems – Hormones fuel nearly every process in our bodies and an imbalance in these hormones can wreak havoc on any system. Many people assume that testosterone is the only hormone responsible for male sexual health but this is incorrect. There are several other hormones that contribute to the male sex drive and all are equally important.
- Prolactin – If Prolactin levels are elevated, this can cause erectile dysfunction in otherwise healthy males. It’s important to check prolactin levels, as an *increase in these levels can point to a pituitary tumor. 
- Thyroid Hormones – Men with hypothyroidism (when thyroid hormone levels are elevated) are more likely to have problems with erectile dysfunction in addition to experiencing problems with fertility. 
- Testosterone – Low levels of the hormone testosterone can be a reason behind erectile dysfunction but this affliction is rarely the sole cause for the problem. 
- Cancer Treatment – In addition to affecting body image, causing depression and harming libido, the hormones used in the treatment of certain cancers can also result in erectile dysfunction. After treatment, some men may never again achieve erection. 
- Diseases in the Blood Vessels – Hypertension, high cholesterol and narrowed or blocked arteries can all result in erectile dysfunction. Men who live with hypertension (high blood pressure) are at a much higher risk of also suffering with erectile dysfunction. Because hypertension causes a disruption in the endothelium, it restricts blood flow to the penis resulting in the inability to achieve or maintain an erection. Unfortunately, not only will the hypertension itself cause erectile dysfunction but most prescription medicines used to treat hypertension will also result in the same outcome. Many studies are pointing to erectile dysfunction as being an early warning sign of hypertension long before other signs and symptoms are present. 
- Injury – Among the injuries that can affect a man’s impotence are any injury in the genital area, a spinal injury or a pelvic fracture. These types of injuries can cause problems with the nervous system which can prevent a man from being able to achieve and retain an erection. These injuries can also result in the loss of sensation in the genital area, pain during intercourse, premature ejaculation and the inability to reach orgasm. 
- Surgery – The surgeries and procedures a man undergoes to treat bladder cancer or prostate cancer often damage the nerves and tissues that are necessary for the function of the sexual organ. Sometimes these nerves *regrow and tissues heal and men *regain the sexual function they had before surgery. More often than not though, men do not *regain the virility they once had. 
- Venous Leak – One cause of erectile dysfunction is when the venous blood begins to leak out of the penis during an erection. Treatment for this specific problem is not favorable at this time but new research is being carried out to find *better ways to help men suffering from this problem. 
Psychological Contributors to Erectile Dysfunction
As stated earlier, for some men the underlying cause of their erectile dysfunction is indeed psychological.
Because the brain is responsible for setting into motion the processes that will result in an erection, we cannot discount its role in the process.
The first step on the path to achieving an erection is to have sexual feelings of excitement. If a man suffers from any disorder that can tamper with those feelings of sexual excitement, the result can be erectile dysfunction.
If a man suffers from depression, anxiety, or excessive stress, these can all be psychological triggers for erectile dysfunction. 
Complications From Erectile Dysfunction
Men who live with erectile dysfunction may find that they suffer from other problems as a result of their sexual disorder.
Some of the complications that arise from erectile dysfunction include:
- Relationship loss, or a strained relationship due to the loss of intimacy between a man and his partner. In any romantic relationship, intimacy is an incredibly important factor. When that intimacy is threatened by issues such as erectile dysfunction, it causes division and strain in the relationship. When looking at contributions to a relationship, having a positive functioning intimate life holds a much *lower weight (15-20%) compared to a negatively functioning intimate life (50-75%). 
- Mental disorders such as depression or anxiety due to erectile dysfunction  This problem is especially complicated as depression can not only be a cause of erectile dysfunction, but erectile dysfunction can cause a man to become depressed. To compound this issue even further, should a man take medicine to treat the depression – it too can cause erectile dysfunction. 
- Inability to have children due to infertility as a result of erectile dysfunction.  Because it is difficult for the man suffering from erectile dysfunction to achieve or maintain an erection, it’s difficult for couples to become pregnant with children.
- In addition to these serious problems, men can also suffer from penile atrophy (loss of sexual function from not using the penis), low self-esteem from not being able to perform as he ought to be able to and an unfulfilled sex life due to his lack of pleasure from intercourse.
Diagnosing Erectile Dysfunction
Once you realize you may have a problem with erectile dysfunction, it’s crucial to speak with your doctor. Erectile dysfunction can cause problems in areas beyond your love life.
It can also often be a warning sign pointing to other, more serious health issues for men. The inability to maintain a firm erection can be an early sign of vascular disease and arteriosclerosis in men. Because of this, if a man continuously experiences problems achieving or maintaining an erection, this should not be ignored. It can be embarrassing to speak with a health care provider regarding the issue of erectile dysfunction but it’s well worth it.
The symptoms of erectile dysfunction are few but the problems it can lead to are many. Look out for these signs:
- Difficulty getting an erection – If you occasionally have problems getting an erection, this is pretty normal. If you are unable to get an erection more often than not, there is probably a problem.
- Difficulty keeping an erection – If you are often unable to keep an erection long enough to *gain pleasure or reach climax, it’s likely time to call the doctor.
- A lack of sexual desire – Again, this isn’t a concern if it happens every now and then but if you find your desire has seriously dwindled, it’s time to chat with your doctor.
It’s a good thing to see your doctor on a regular basis regardless of your genital health but this is especially important if you have heart disease, diabetes or any other health condition linked to erectile dysfunction. 
During your examination, your doctor will check you over to try to determine what the issue is. Be open and honest with them even if it seems embarrassing.
- Your doctor will discuss your medical and sexual history with you. This will help your doctor to determine whether or not you have any underlying health problems that could result in erectile dysfunction. Your doctor can also help you to discern if the issues you are facing are erectile problems, ejaculatory problems, desire problems or something else entirely.
- Your doctor will perform a physical exam on you, to see if there are concrete, demonstrable signs of erectile dysfunction. He will check to see if your penis has any unusual qualities that could be causing the problems. He will check to see if your penis responds to touch (this verifies that your nervous system is functioning properly). He will also monitor other things (like hair loss, for example) that can be indicative of hormonal issues.
- Your doctor may send in laboratory tests like lipid panels to check your cholesterol, thyroid panels to check your thyroid function and testosterone panels to measure your testosterone levels. To check for diabetes, he will run a urinalysis, a liver panel and glucose test. To check your kidneys, he will run a renal panel including creatinine.
- Your doctor may send you to have an ultrasound done. The technician or doctor performing the ultrasound will use the device to check the blood vessels in your penis. This will help your doctor to determine whether or not there are problems with the blood flow to the penis that are preventing you from getting an erection.
- Sometimes, they may also have you undergo a psychological examination just to determine if you are dealing with any of the psychological problems that can lead to erectile dysfunction. If you allow it, they may also wish to speak with your sexual partner. There is no need to stress out or be worried about this appointment. Remember that erectile dysfunction is unfortunately fairly common, so your doctor has seen it all before. He wants to help you fix this problem in your life so that you can get back to being you and enjoying all parts of your life including your sexual life.
Treating Erectile Dysfunction
Because every man is different, the treatment for erectile dysfunction will be different for each man who reaches out to his doctor for help. Your doctor will take many things into consideration when determining the best course of treatment for your erectile dysfunction.
If you have any underlying conditions such as diabetes, high cholesterol or high blood pressure, your doctor will first make sure you are getting the correct medications and treatment for those.
There are several oral medications your doctor can suggest for you to try.
These medications work by amplifying your body’s reaction to nitric oxide which is the chemical in your body that relaxes your penile muscles. When the muscles of your penis are relaxed, they allow more blood to flow in resulting in you getting an erection if you have been sexually aroused. Don’t worry, they won’t give you an automatic erection without outside stimuli, they simply allow your body to function like it is supposed to.
The most common oral medications prescribed for erectile dysfunction are:
- Sildenafil citrate, otherwise known as Viagra. With sexual stimulation, most men can achieve an erection within 60 minutes of taking Viagra. Viagra is very effective for the treatment of erectile dysfunction. It’s also quite safe and most men tolerate it well. 
- Vardenafil citrate, also known as Levitra or Staxyn. This medicine is similar to Viagra in its chemical makeup and in the way it works. Evidence has shown these medications work well in men who have other underlying conditions such as diabetes and hypertension. 
- Tadalafil citrate, known also as Cialis or Adcirca. In most men, this medication takes a lot longer for the body to absorb – up to 5 hours before an erection can be obtained. However, this medication can stay effective in the body for up to 36 hours. These medications are very useful for treating men who have a high number of other health issues that *increase their propensity to develop erectile dysfunction. This medication can also be taken once daily rather than on demand which makes it the smart choice for a *growing number of men, 
You should never take any of these medications if you are also taking heart medication that contains nitrates, if you have heart disease or if you have low blood pressure. Be sure to speak with your doctor about any of these issues before obtaining these medications.
Other Medications and Treatment Options
In addition to the oral medication options to treat erectile dysfunction, there are other options that may work *better for you.
Your doctor could prescribe an injection that you administer yourself when you need to have an erection. With this medication, you would use a fine needle and inject the medication into your penis and you will achieve an erection that should last no more than one hour.
Another option your doctor could give you is a suppository that is placed into your urethra.
Depending on the severity of your erectile dysfunction, you doctor may prescribe hormone replacement therapy. If your doctor provides you with testosterone therapy, there are many different forms this can take. You can get this medication in a cream or a gel, as a skin patch, an injection or as a pellet. Testosterone therapy can be useful for men who do not achieve erection from oral medication alone. 
Yet another approach is the use of a penis pump. This is a device that uses a vacuum to create an erection. A hollow tube is placed over your penis, and then a hand or battery powered pump is used to draw the air out of the tube. This results in a vacuum that will slowly force the blood into your penis resulting in an erection. To keep the erection, you place a ring around the base of your penis to keep the blood in place and then you remove the pump. This option is a promising one for men who have suffered nerve injury and cannot obtain erection from stimulation. 
The most invasive method – and the last resort for most doctors and the men they treat – is a penile implant. This method of treatment is done by surgically inserting devices into the penis. The implants can be either inflatable or bendable rods. If you opt for the inflatable rods, when you want an erection you fill the cylinders with a saline solution and when you are finished you drain the solution. For the bendable rods, you simply *raise your penis into an erect position and bend it back when you are through. When all other options fail, many men have been pleased with the results of penile implant surgeries. 
Many men are embarrassed to look for help when it comes to sexual problems. Unfortunately, this can delay proper diagnosis and treatment of other health problems as well, since we know that erectile dysfunction is comorbid with many other diseases and disorders.
Men need not be afraid to speak up about any health problem they are facing including sexual health problems. Doing so might even save your life.
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