Stephen W Leslie, MD, FACS
Joseph A Salomone III, MD
Francisco Talavera, PharmD, PhD
Impotence/Erectile Dysfunction Introduction
Erectile dysfunction (ED) or male impotence is defined as the inability of a man to achieve and maintain an erection sufficient for mutually satisfactory intercourse with his partner.
Sexual health and function are important determinants of quality of life. As Americans age, disorders such as erectile dysfunction (ED) or impotence are becoming increasingly more important. Because this subject is discussed widely in the media, men and women of all ages are seeking guidance in an effort to improve their relationships and experience satisfying sex lives.
Sexual dysfunction is often associated with disorders such as diabetes, high blood pressure, heart disease, nervous system disorders, and depression. Erectile dysfunction may also be an unwanted side effect from medication. In some men, sexual dysfunction may be the symptom of such disorders that brings them to the doctor's office.
The successful treatment of impotence has been demonstrated to improve intimacy and satisfaction, improve sexual aspects of quality of life as well as overall quality of life, and relieve symptoms of depression.
Premature ejaculation is often confused with erectile dysfunction. Premature ejaculation is a condition in which the entire process of arousal, erection, ejaculation, and climax occur very rapidly, often in just a few minutes or even seconds, leaving the partner unsatisfied. Premature ejaculation may accompany an erection problem such as ED but is generally treated differently.
Although this information focuses primarily on male ED, remember that the partner plays an integral role. If successful and effective management is to occur, any discussion of treatment should include the couple.
- For a man to have an erection, a complex process takes place within the body.
- Erection involves the central nervous system, peripheral nervous system, psychological and stress-related factors, local problems with the erection bodies or penis itself as well as hormonal and vascular (blood flow or circulation) factors. The penile portion of the process leading to erections represents only a single component of a very complicated and complex process.
- Erections occur in response to touch, smell, and visual stimuli that trigger pathways in the brain. Information travels from the brain to the nerve centers at the base of the spine, where primary nerve fibers connect to the penis and regulate blood flow during erection and afterward.
- Sexual stimulation causes the release of chemicals from the nerve endings in the penis that trigger a series of events that ultimately cause muscle relaxation in the erection bodies of the penis. The smooth muscle in the erection bodies controls the flow of blood into the penis. When the smooth muscle relaxes, the blood flow dramatically increases, and the erection bodies become full and rigid, resulting in an erection. Venous drainage channels are compressed and close off as the erection bodies enlarge.
- Detumescence (when the penis is no longer in a state of erection) results when muscle-relaxing chemicals are no longer released. Ejaculation causes the smooth muscle tissue of the erection bodies in the penis to regain muscle tone, which allows the venous drainage channels to open and the blood drains from the penis.
- Sexual dysfunction is extremely common in men.
- In the Massachusetts Male Aging Study (MMAS) among a community-based survey of men aged 40-70 years, 52% of the men reported some degree of erectile difficulty. Complete ED, defined as the total inability to obtain or maintain suitable erections during sexual stimulation, as well as the absence of nocturnal erections (erections during sleep), occurred in 10% of the men in the study. Lesser degrees of mild and moderate ED occurred in 17% and 25% of participants.
- In the National Health and Social Life Survey (NHSLS), a nationally representative sample of men and women aged 18-59 years, 10.4% of men reported being unable to achieve or maintain an erection during the past year.
- Judging from research results, an estimated 18-30 million men are affected by ED.
- Other male problems, such as premature ejaculation and loss of libido (decreased sexual desire), are also very common. The NHSLS found that 28.5% of men aged 18-59 years reported premature ejaculation, and 15.8% lacked interest during the past year. An additional 17% reported anxiety about sexual performance, and 8.1% indicated a lack of pleasure from sexual activity.
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Erectile dysfunction (or ED), also called male impotence, describes a man's inability to achieve and maintain an erection of his penis sufficient for mutually s...learn more >>