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Healthcare

Erectile Dysfunction

About

About

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex.

Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect your self-confidence and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

If you're concerned about erectile dysfunction, talk to your doctor — even if you're embarrassed. Sometimes, treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed.

Symptoms

Symptoms

Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

When to see a doctor

A family doctor is a good place to start when you have erectile problems. See your doctor if:

  • You have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation
  • You have diabetes, heart disease or another known health condition that might be linked to erectile dysfunction
  • You have other symptoms along with erectile dysfunction

Pap test (also called Pap smears)

This blood test measures the prostate specific antigen (PSA) levels in the blood. Antigens are any substances that evoke responses from a person's immune system. The prostate specific antigen levels can be elevated in the presence of prostate cancer. However, it is important to understand that other benign prostate conditions may also elevate PSA, such as benign prostatic hyperplasia (BPH), which is noncancerous swelling of the prostate. The PSA test is not recommended for all men, and there is considerable controversy over the role of PSA testing. Some organizations, such as the United States Preventive Services Task Force (USPSTF), now recommend against PSA screening. The pros and cons of PSA screening should always be discussed with your healthcare provider before testing. Some of the cons include unnecessary testing and procedures, unnecessary costs, and significantly increased anxiety.

Mammography

Many organizations, including the USPSTF, recommend mammography screening for breast cancer every 1 year to 2 years after age 50. This test is done in conjunction with a clinical breast exam

Colonoscopy

Many organizations, including the USPSTF, recommend screening for colon cancer or colon polyps at age 50, earlier if you have a family history or other risk factors

Diabetes or prediabetes

The American Diabetes Association (ADA) recommends that all adults be screened for diabetes or prediabetes starting at age 45, regardless of weight. Additionally, individuals without symptoms of diabetes should be screened if they are overweight or obese and have one or more additional diabetes risk factors.

Consult your healthcare provider regarding all of these as well as other types of screening tests, based on your medical condition, as not all healthcare providers are in agreement in regard to which screening tests should be done and for which age groups.

Causes

Causes

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen erectile dysfunction.

Sometimes a combination of physical and psychological issues causes erectile dysfunction. For instance, a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection. The resulting anxiety can lead to or worsen erectile dysfunction.

Physical causes of erectile dysfunction

In many cases, erectile dysfunction is caused by something physical. Common causes include :

  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
  • Metabolic syndrome — a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
  • Parkinson's disease
  • Multiple sclerosis
  • Certain prescription medications
  • Tobacco use
  • Peyronie's disease — development of scar tissue inside the penis
  • Alcoholism and other forms of substance abuse
  • Sleep disorders
  • Treatments for prostate cancer or enlarged prostate
  • Surgeries or injuries that affect the pelvic area or spinal cord

Psychological causes of erectile dysfunction

The brain plays a key role in triggering the series of physical events that cause an erection, starting with feelings of sexual excitement. A number of things can interfere with sexual feelings and cause or worsen erectile dysfunction. These include :

  • Depression, anxiety or other mental health conditions
  • Stress
  • Relationship problems due to stress, poor communication or other concerns
Risk Factors

Risk Factors

As you get older, erections might take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection.

Various risk factors can contribute to erectile dysfunction, including :

  • Medical conditions, particularly diabetes or heart conditions
  • Tobacco use, which restricts blood flow to veins and arteries, can — over time — cause chronic health conditions that lead to erectile dysfunction
  • Being overweight, especially if you're obese
  • Certain medical treatments, such as prostate surgery or radiation treatment for cancer
  • Injuries, particularly if they damage the nerves or arteries that control erections
  • Medications, including antidepressants, antihistamines and medications to treat high blood pressure, pain or prostate conditions
  • Psychological conditions, such as stress, anxiety or depression
  • Drug and alcohol use, especially if you're a long-term drug user or heavy drinker
Complications

Complications

Complications resulting from erectile dysfunction can include:

  • An unsatisfactory sex life
  • Stress or anxiety
  • Embarrassment or low self-esteem
  • Relationship problems
  • The inability to get your partner pregnant
Prevention

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example:

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.