What Is Impotence/Erectile Dysfunction? What Are Impotence Symptoms and Signs?
Erectile dysfunction (ED) or male impotence is defined as the inability of a male to achieve and/or maintain a hard enough erection sufficient for satisfactory completion of sexual activity.
Sexual health and function are important determinants of quality of life. As males age, erectile dysfunction (ED) or impotence is more common. Erectile dysfunction often has a negative impact on sex life and overall quality of life for both the male experiencing the erectile troubles and his partner.
Erectile dysfunction is often associated with a number of common medical conditions, such as diabetes, high blood pressure, heart disease, nervous system disorders, depression, and the medications used to treat these conditions. Psychologic problems such as anxiety and stress can also affect erectile function.
The successful treatment of erectile dysfunction (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.
Erectile dysfunction is only one cause of sexual dysfunction. Other causes of sexual dysfunction include troubles with ejaculation, decreased libido, and troubles achieving an orgasm (climax). Some men may have premature ejaculation, which 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. Troubles with erectile function may lead to decreased libido or interest in sex, however, many men with decreased libido have normal erectile dysfunction. Libido may be affected by psychologic factors, such as stress, anxiety, or depression but often is the result of a low testosterone (the male hormone) level.
As sexual activity often involves a partner, it is important to try to involve the partner in the evaluation and management of erectile dysfunction and determine if assistance with relationship problems will be needed. Sex therapists are helpful in assisting couples deal with sexual relationship difficulties.
Physiology of a Natural Erection
Penile Anatomy and Function
The penis is composed of three cylinders, two on the top and one on the underside of the penis. The top two cylinders are involved in the erectile process. The urethra, the tube that urine and semen pass through, is on the underside of the penis. The top two penile cylinders, the corpora cavernosa, are composed of tissue that is analogous to a sponge, containing spaces that can fill with blood and expand. These two cylinders are surrounding by a strong layer of tissue, like Saran wrap, the tunica albuginea. For an erection to occur, there must be properly functioning nerves, arteries, veins, and normal penile tissues.
- When aroused, stimulated nerves supplying the penis release chemicals that cause the muscle that surrounds blood vessels in the penis to relax. As the blood vessels relax, there is an increase in blood coming into the penis. This blood fills the spaces in the corpora cavernosa, allowing each of the corpora to expand. As the corpora expand, the veins that drain blood out of the penis are compressed against the tunica albuginea. Compression of the veins prevents blood from leaving the penis and results in a fully rigid penis. When the stimulation/arousal subsides, there is a decrease in the chemicals from the nerves, the muscle around the arteries tightens, decreasing inflow of blood, resulting in a lack of compression of the veins and the drainage of blood out of the penis.
- Thus, any medical condition that affects nerves, arteries, or veins may have an impact on erectile function.
Incidence of Erectile Dysfunction
- Erectile dysfunction is extremely common in men and the risk of developing erectile dysfunction increases with 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 form of sexual dysfunction, 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.