Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or that of his partner. Most men experience this at some point in their lives, usually by age 40, and are not psychologically affected by it.

However, some men experience chronic, complete erectile dysfunction (impotence), and others, partial or brief erections. Frequent erectile dysfunction can cause emotional and relationship problems, and often leads to diminished self-esteem. Erectile dysfunction has many causes, most of which are treatable, and is not an inevitable consequence of aging.

Incidence of the disorder increases with age. Chronic ED affects about 5% of men in their 40s and 15% - 25% of men by the age of 65. Transient ED and inadequate erection affect as many as 50% of men between the ages of 40 and 70.

Diseases such as diabetes, kidney disease, alcoholism and atherosclerosis, account for as many as 70% of chronic ED cases and psychological factors such as stress, anxiety and depression may account for 10 - 20% of cases. Between 35 and 50% of men with diabetes experience ED.

What happens during an Erection?

The physiological process of erection begins in the brain and involves the nervous and vascular systems. Neurotransmitters in the brain (e.g. epinephrine, acetylcholine, nitric oxide) are some of the chemicals that initiate it. Physical or psychological stimulation (arousal) causes nerves to send messages to the vascular system, which results in significant blood flow to the penis. Two arteries in the penis supply blood to erectile tissue and the corpora cavernosa, which become engorged and expand as a result of increased blood flow and pressure.

Because blood must stay in the penis to maintain rigidity, erectile tissue is enclosed by fibrous elastic sheathes (tunicae) that cinch to prevent blood from leaving the penis during erection. When stimulation ends, or following ejaculation, pressure in the penis decreases, blood is released, and the penis resumes its normal shape.

What causes Impotence?

There are many underlying physical and psychological causes of erectile dysfunction. Reduced blood flow to the penis and nerve damage are the most common physical causes. Underlying conditions associated with erectile dysfunction include the following:

• Vascular disease
• Diabetes
• Drugs
• Hormone disorders
• Neurological conditions
• Pelvic trauma, surgery, radiation therapy
• Peyronie's disease
• Venous leak
• Psychological conditions

Can it be treated?

Yes. You can read about are various forms of treatment available on the treatment page, or you can complete a free medical consultation with one of our qualified GMC doctors. There is no obligation to buy any treatments that the doctor may suggest, and the entire process is confidential.