Erectile dysfunction (ED), formerly termed impotence, is defined as the failure to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse. While no specific time is part of this definition, some have suggested that the condition needs to persist for six months. ED is a common condition in men who are 40 years and older; prevalence increases with age and other co-morbidities.
ED can be a symptom of a wide range of underlying pathologies and is an essential but underutilized cardiovascular risk factor. Any disease process that affects penile arteries, nerves, hormone levels, smooth muscle tissue, corporal endothelium, or tunica albuginea can cause erectile dysfunction. This condition is closely related to cardiovascular disease, diabetes mellitus, hyperlipidemia, and hypertension, among other disorders. Endothelial dysfunction appears to be the other common pathway in patients with this condition.
While the vast majority of patients with ED will have organic disease, some may have a primary psychological issue, particularly younger men. Even when the underlying cause is organic, there are almost always psychological consequences to ED regarding marital and relationship issues, cultural norms and expectations, loss of self-esteem, shame, anxiety, and depression, among others. ED can cause considerable emotional damage to the patient and their partner, as well as have a significant impact on their quality of life. Fortunately, ED is almost always treatable.
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