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Impotence/Erectile Dysfunction

Impotence/Erectile Dysfunction Facts

Erectile dysfunction (ED) or male impotence is defined as the inability of a male 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. Sexual dysfunction may also be related to nonpathological states, such as anxiety, fatigue, and psychosocial stress. Erectile dysfunction may also be an unwanted side effect from certain medications. 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 couple intimacy, improve sexual satisfaction, improve male self-esteem, and overall quality of life. In some men, it may also relieve symptoms of depression.

Moreover, the condition of 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 educational review focuses primarily on the male with ED (difficulty to achieve and maintain erection), it is important to note that the partner plays an integral role in the process and treatment. If successful and effective management is to occur, any discussion of treatment should include the couple. Involvement of a sexologist is often recommended to help the couple deal with the relationship difficulties that encompass ED.

Physiology of a Natural Erection

  • For a man to have an erection, a complex neurovascular process takes place within the body.
    • Male 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 engorge with blood and enlarge.
    • Detumescence (when the penis is no longer in a state of erection) results when muscle-relaxing chemicals are no longer released. At orgasm, sympathetic-system mediated 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.

Incidence of Erectile Dysfunction

  • Erectile dysfunction is extremely common in men. It is age-dependent, and its incidence increases after the 40-50 years of age.
    • 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 (normal erections [four to six/night], which occur 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 18-59 years of age, 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.

Incidence of Premature Ejaculation

  • 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 18-59 years of age 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.
Medically Reviewed by a Doctor on 7/29/2015

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