Erectile Dysfunction

    ED is the inability to get or keep an erection firm enough for sexual intercourse. ED can be a
    total inability to achieve an erection, an inconsistent ability to do so, or a tendency to
    sustain only brief erections.

    ED is sometimes called impotence, but that word is being used less often so that it will not
    be confused with other, nonmedical meaning

    ED usually has a physical cause, such as disease, injury, or side effects of drugs. Any
    disorder that causes injury to the nerves or impairs blood flow in the penis has the potential
    to cause ED.

    Because an erection requires a precise sequence of events, ED can occur when any of the
    events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and
    area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and
    near the corpora cavernosa.

    Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of
    disease, is the most common cause of ED. Diseases—such as diabetes, high blood
    pressure, nerve disease or nerve damage, multiple sclerosis, atherosclerosis, and heart
    disease—account for the majority of ED cases. Patients should be thoroughly evaluated for
    these conditions before they begin any form of treatment for ED.

    Lifestyle choices that contribute to heart disease and vascular problems also raise the risk
    of ED. Smoking, drinking alcohol excessively, being overweight, and not exercising are
    possible causes of ED.

    Surgery—especially radical prostate and bladder surgery for cancer—can also injure nerves
    and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder,
    and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and the fibrous
    tissues of the corpora cavernosa.

    In addition, ED can be a side effect of many common medicines such as blood pressure
    drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and
    cimetidine, an ulcer drug.

    Psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of
    sexual failure can also cause ED. Even when ED has a physical cause, psychological factors
    may make the condition worse.
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