Male Sexual Dysfunction (Impotence, ED)

Sexual dysfunctions are disorders related to a particular phase of the sexual response cycle. Male sexual dysfunction (MSD) is a global term encompassing a diversity of disorders. The three most common male sexual dysfunctions are premature ejaculation, erectile dysfunction, and low libido. Existing data suggests that problems impacting sexual performance and sex drive affect 10 to 50 percent of American men.

Erectile Dysfunction (ED)

Erectile dysfunction is the inability to get or maintain an erection for satisfactory sexual intercourse or activity.

Almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In defining ED it is important to specify that it is the consistent inability of a man to get or maintain an erection. If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.

In the last 20 years there has been increasing recognition that erectile dysfunction is one of the most common sexual problems, and usually the most troubling form of male sexual dysfunction. Erectile dysfunction can occur at any age, but it is more common in men older than 65. It becomes more common and severe as men get older.

Patterns of erectile dysfunction include: inability to obtain a full erection, inability to maintain an erection throughout intercourse, complete inability to achieve an erection.

In around 95% of the cases, a suitable treatment can be found. Erectile dysfunction is treatable at all ages. Treatments include psychotherapy, drug therapy, vacuum devices, surgery and natural hermal remedies.

Causes and risk factors

Achieving and sustaining an erection requires interaction between the neurological, arterial, hormonal, and psychological functions of the body.

There are a number of causes of ED. Reduced blood flow to the penis and nerve damage are the most common physical causes. Almost any disease may affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the corpora cavernosa or influence the patient's psychologic mood and behavior.

  • Age. All studies demonstrate a strong association with age. The independent association with aging suggests that vascular changes in the arteries and sinusoids of the corpora cavernosae are contributing factors. With aging comes an increase in the number of venous channels, often with venous incompetence, so that if blood does effectively enter the penis, it may leak out too easily. Other risk factors associated with aging include depression, sleep apnea, and low levels of high-density lipoproteins.

  • Physical health problems. Damage to nerves, arteries, smooth muscles, and fibrous tissues as a result of disease, is the most common cause of ED.
    • Vascular diseases. Several conditions prevent sufficient blood getting into the penis and so cause erectile dysfunction.
      Atherosclerosis - the hardening and narrowing of the arteries, causes a reduction in blood flow throughout the body and can lead to impotence. It is associated with age and accounts for 50% to 60% of impotence in men over 60.
      Peripheral vascular disease
      High blood pressure
      Veno-occlusive disease (problems with keeping the blood within the penis, resulting in erections that are quickly lost)
    • Systemic diseases.
      Diabetes mellitus - can affect blood vessels and nerves in various parts of the body and is a major cause of erection problems. Diabetes has an impact on both blood supply to the penis and the nervous control needed to maintain an erection.
      Scleroderma
      Renal failure
      Liver cirrhosis
    • Neurologic Conditions can cause impotence when they interrupt the transfer of nerve impulses from the brain to the penis.
      Epilepsy
      Stroke
      Spinal cord and brain injuries
      Multiple sclerosis
      Parkinson's disease
      Alzheimer disease
    • Penile conditions. There are a number of conditions affecting the tissues in the penis that if left untreated, will have an impact on the ability to maintain an erection.
      Peyronie's Disease (bent penis)
      Epispadias
      Priapism (when erection lasts for hours becoming very painful)

      In a small number of cases, problems with hormone levels, can also affect erection.
    • Hormone Disorders account for fewer than 5% of cases of impotence. Testosterone deficiency, which occurs rarely, can result in a loss of libido (sexual desire) and loss of erection. Among other conditions, an excess of the hormone prolactin, caused by pituitary gland tumor, reduces levels of testosterone. Hormone imbalances can also result from kidney or liver disease.
  • Prostate or bladder surgery. Sometimes surgery to the prostate or pelvis where there has been nerve or tissue damage may cause erectile dysfunction.
  • Trauma or Injury. Damage to the nerves that control erections, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa can cause erectile dysfunction. It may result from an injury to the pelvic area, spinal cord, prostate, bladder. Prolonged bicycle riding also can cause a temporary problem.
  • Medications. Over 200 commonly prescribed drugs are known to cause or contribute to erectile dysfunction. Such medications include:
    blood pressure drugs, antihistamines, antidepressants, anticonvulsants, tranquilizers, appetite suppressants, anti-ulcer medications.
  • Psychological aspects. Psychological problems can also influence the ability to get and maintain erections. Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10-20% of ED cases. If a man experiences loss of erection, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to chronic problems during sex. If the cycle is inescapable, it can result in impotence. Psychological factors in impotence are often secondary to physical causes, and they magnify their significance. Psychological causes include:
    • Depression
    • Anxiety
    • Stress or tiredness
    • Guilt or 'hang-ups' about sex
    • Fear of failure because of recent problems with erection
    • Relationship problems or marital disharmony
    • Loss of attraction to partner
    • Bereavement
    • Pressure to perform
    • Premature ejaculation
    • Child or adult sex abuse
  • Substance abuse. Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive. Excessive tobacco use also can damage penile arteries. Heavy smokers are particularly at risk from poor circulation and therefore problems with erection.

Low sex drive

Hypoactive Sexual Desire (low libido, decreased sexual desire) is a very common sexual disorder. It refers to a low level of sexual desire and interest manifested by a failure to initiate or be responsive to a partner's initiation of sexual activity. Most men with lack of libido can achieve erections, but have lost the desire to have sex. It is NOT normal for a person to have no sexual desire.

Causes and risk factors

Low sexual desire can be a result of psychological problems or physical conditions. In order to find an effective solution, it is important to identify what has triggered it. Possible causes can include:

  • Age. As an individual ages many changes occur in the body that affects sexual desire.
  • Hormone deficiency. Decreased amounts of testosterone in the body are liked with declines in sexual desire
  • Depression. People who suffer from depression usually have a general decrease in mood, which tends to decrease their sexual motivations and activity.
  • Anxiety & stress. If the individual suffers from either of these conditions, it may cause temporary to more long-term decrease in sex drive, depending on the amount of stress or anxiety being experienced.
  • Medications. Certain medications may affect sexual desire: antihistamines, antidepressants, anticonvulsants, tranquilizers, appetite suppressants.
  • Physical health conditions, such as diabetes, cardiovascular disease, Parkinson's disease, endocrine or neurological disorders, chronic pain.
  • Sexual abuse.
  • Insomnia or inadequate amounts of sleep, resulting in fatigue.
  • Relationship Problems. Unresolved conflict or unexpressed anger, negative feelings, secrets or emotional upset.
  • Addictions. Alcohol-related problems, abuse of drug.
  • Obesity.
  • Male andropause.





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