Impotence or the erectile dysfunction is the incapacity get or maintain an erection that is firm enough for sex. This is a common condition that occurs to many men occasionally especially during times of stress. Therefore, having occasional erection problem from time to time is not necessarily a cause for an alarm.However, frequent Erectile Dysfunction could be a great sign of health problems that require treatment. This could be a sign of relationship or emotional difficulties, which might need the attention of a professional to address. Moreover, having problems in getting and keeping erection can also be an underlying medical condition and a risk factor heart disease and therefore requires treatment.
The condition can result from physical or psychological cause, which can be identified by accessing how the problem started or developed. If the situation happens slowly but gets worse consistently, then it is more likely to result from a physical cause.
This is how chronic impotence begins and develops. On the other hand, if the problem happens suddenly but you can have firm erections in the morning or while masturbating, then the cause of the condition may involve your mind or a physical cause too.
However, it is essential to consult your doctor if you are concerned about erectile dysfunction without any feeling embarrassed as this is a common condition that affects many men.
Besides, erectile dysfunction can in most cases be reversed by treating an underlying health condition while medications or other treatments might be required.
What is Impotence?
Impotence is a form of erectile dysfunction. The condition affects the ability of a person to achieve or maintain an erection or the ability to have a proper ejaculation.
According to research, there are several contributing factors for this condition. These factors range from emotional to physical disorders.
The risk of impotence increases* with age as studies show that about half of the population of men within the age of to experiences[1] some form of erectile dysfunction at one point or another.
Moreover, studies have shown that men with more education are less likely to suffer from impotence. This is attributed to their ability have healthier lifestyles as compared to the less educated men. Impotence is a serious problem to many men as it negatively affects their sex life, which might lead to new depression, stress and low self-esteem.
Fortunately, the condition can easily be addressed by understanding the potential causes and ensuring* that you have a healthier lifestyle.
What Is Impotence?
What are The Symptoms of Impotence?
The common erectile symptoms might include persistent:
Problem in Achieving an Erection
This can significantly affect your sex life and result in more emotional problems such as depression, loss of confidence and stress.
Trouble in maintaining an Erection
Being unable to keep an erection that is firm enough to have sexual intercourse, can also affect your performance in bed. Having difficulty in keeping an erection, is one of the worst conditions that any man would wish to experience.
Reduced* Sexual Desire
The other common symptom of impotencies is the reduced* sexual desire or loss of interest in engaging in sexual intercourse. The condition can cause enormous strain in relationships, as such men are unable to satisfy their other half or another partner.
Besides, reduced* sexual desire can also affect a man emotionally as it may lead to low self-esteem, depression, and stress.
When Do I Consult A Doctor?
Consult A Doctor
Many men find it hard to determine when to see a doctor as occasional erectile dysfunction is common. However, it is essential to consult your doctor when erectile dysfunction symptoms[1] start to worry you so much by causing anxiety or threatening to spoil your sexual relationship.
Consulting a doctor can significantly help in clearing up misinformation that might aggravate the matter even further. Besides, a doctor may at times prescribe some medications that can enable you to get through the rough patch by taking them for a short time.
Moreover, a doctor will address erectile dysfunction that results from other conditions such as Peyronie’s disease. This refers to a condition where it becomes painful or difficult for you to achieve an erection because your penis is curved.
However, this could be a warning sign of a severe underlying problem if it lasts longer. For instance, having pain or finding it difficult to get an erection could be due to a narrower penis artery, which might result from diabetes or coronary artery disease.
Finally, the doctor may suggest that you take some medications in the form of an injection in your penis, pills or use a mechanical device to help your erections.
However, you will be required to deal with the underlying health issue if you want to overcome this condition completely. Here are some of the cases when you should see or consult your doctor, see your doctor if:
You happen to have some concerns about your erections or if you are experiencing other, sexual related problems like delayed or premature ejaculation.
You have a health condition that is associated with erectile dysfunction such as heart disease or diabetes.
You happen to have other symptoms that aggravate the erectile dysfunction problem
Common Causes of Erectile Dysfunction (Impotence)
Many factors might lead to erectile dysfunction. This is because male sexual arousal involves many parts of the body that include the brain, nerves, emotions, muscles and blood vessels.
Therefore, male sexual arousal is a complex process is affected by any problem on the parts involved. Any effect on the male sexual arousal leads to erectile dysfunction, but mental health concerns or stress can cause or worsen the condition[2].
In some cases, erectile dysfunction results from a combination of psychological and physical issues.
For example, suffering from a minor physical condition that affects your sexual response might cause anxiety and therefore affect your ability to maintain an erection. The resulting anxiety can cause or worsen erectile dysfunction.
Psychological Causes Of Erectile Dysfunction
One of the most important organs of male sexual arousal is the brain as it plays a crucial role in triggering sexual excitement and a series of other physical events that result in a firm erection.
Therefore, several things that affect the functioning of your brain can interfere with sexual feelings and cause or worsen the condition. Some of the common psychological causes include:
Stress
Stress and other psychological issues are the main cause of erectile dysfunction, especially among relatively young men.
Depression, Anxiety As Well As Other Mental Health Conditions
Depression, anxiety, guilt may also cause or worsen erectile dysfunction. It is also important to note that most of the medications that are used in the depression treatment or other psychological disorders may also cause ejaculation issues or erectile dysfunction.
Problems related to stress, poor communication or other concerns
Physical Causes Of Erectile Dysfunction
Some of the common physical causes of erectile dysfunction include:
Cardiovascular or Heart Diseases
Heart Diseases
According to several studies, most cardiovascular diseases results from atherosclerosis. This refers to a condition that results from narrowing and hardening of the arteries, which lowers blood flow.
In most cases, atherosclerosis affects all arteries in the entire body where high cholesterol levels, diabetes mellitus, hypertension and cigarette smoking aggravate the condition.
Narrowing and stiffening of the arteries around the pelvic organs or penis may prevent a proper flow of blood into the male sexual organ. Different studies have shown a strong relationship between erectile dysfunction and the severity of atherosclerosis in the heart arteries.
For instance, men with severe stiffening of the heart arteries or atherosclerosis in the coronary arteries tend to suffer more impotence as compared to men with less serious or no atherosclerosis.
Hypertension
Several studies have shown that men with high blood pressure have a higher risk of developing erectile dysfunction. High blood pressure can cause problems with erections linked to atherosclerosis or low levels of nitric oxide produced in the penis arteries.
Diabetes Mellitus
According to some studies, impotence tends to begin about years earlier in diabetic men as compared to non-diabetic men. The high risk of developing erectile dysfunction among men with diabetes may be caused by significant severity or earlier onset of hardening of arteries, which reduces* the flow of blood the penis. Besides, diabetes mellitus may cause erectile dysfunction by damaging the nerves that lead to the penis or other areas of the body.
The disease can also affect penis muscles making it difficult for such men to achieve an erection. Therefore, poor control of blood glucose levels and obesity can significantly increase* the risk of developing erectile dysfunction.
Injury To The Spinal Cord or Nerves
The other common cause of erectile dysfunction is the damage of the nerves around the pelvic region or the spinal cord. Nerve damage may result from trauma, disease or surgical operations gone wrong.
These include nerves injury in the pelvic area after surgery to prostate cancer patients (prostatectomy), spinal cord injuries from automobile accidents and colorectal cancer surgeries.
Moreover, nerves damage may result from prostate enlargement surgeries, prostate radiation, long-term diabetes mellitus and multiple sclerosis.
Cigarette Smoking
Cigarette Smoking
Cigarette smoking can lead to spasms of the arteries (vasospasm), aggravates atherosclerosis, and therefore increase* the risk of developing impotence.
Medications
According to studies, most common medicines come with impotence as one of the potential side effects. Some of the medicines that may lead to erectile dysfunction include drugs that prescribed to treat* depression, hypertension, antihistamines, appetite suppressants and tranquilizers.
Hypogonadism (Low Levels of Testosterone)
Testosterone is the major sex hormone that brings about the libido or sex drive in men but is also vital in maintaining the right levels of nitric oxide in the sex organ. Consequently, men with low testosterone levels tend to have a low libido and impotence.
Aging
Typically, older men are more likely to experience erectile dysfunction as compared to younger men.
This is because older men have a higher risk of developing diseases that are linked to erectile dysfunction like cardiovascular disease, diabetes mellitus, angina, heart attacks, strokes and high blood pressure. Besides, aging process also causes changes in the tissue and muscle within the penis leading to erectile dysfunction.
Substance Abuse
Studies have shown that abusing certain substances may contribute to erectile dysfunction. These include heroin, cocaine, crystal meth, marijuana, narcotic, methamphetamines, and alcohol abuse.
For instance, alcoholism may cause damage to the nerves, lower testosterone levels, and lead to atrophy (shrinking) of the testicles.
Common Risk Factors for Erectile Dysfunction
Getting and keeping a firm erection might take longer and become difficult as you age. Consequently, you might need direct touch to your penis to achieve and maintain an erection. Here are some of the risk factors[3] that might contribute to erectile dysfunction:
Certain Medical Conditions
Medical Conditions
This includes health conditions associated with erectile dysfunction such as diabetes mellitus and heart conditions.
Obesity Or Being Overweight
This is linked to narrowing and hardening of arteries, high blood cholesterol levels, which affects the flow of blood to the penis or lead to other health conditions that are linked to erectile dysfunction.
Tobacco Use
Long-term tobacco use restricts blood flow in the arteries and the veins, which might lead to chronic health conditions over time that are linked to erectile dysfunction.
Medications
Most common medications lead to erectile dysfunction. These include antihistamines, antidepressants, and other drugs that are used in the treatment of high blood pressure, pain or prostate conditions.
Severe Injuries
Suffering from severe injuries that may lead to the damage to nerves or arteries that control erections increase* the risk of developing erectile dysfunction.
Substance and Alcohol Use
Excessive use of alcohol or long-term use of drugs increases* the risk of experiencing the condition.
Psychological Conditions
Various psychological conditions such as anxiety, depression or stress may cause or worsen the condition.
Certain Medical Procedures Or Treatments
Some of the medical treatments such as prostate surgery or radiation treatment for cancer increases* the risk of erectile dysfunction. This is because they might cause damage to the nerves or affects the flow of blood to the pelvic region.
How is Erectile Dysfunction Diagnosed?
Erectile Dysfunction Diagnosed
Diagnosing the condition is relatively easy as the doctor asks you about your symptoms and health history. Moreover, the doctor may carry out some tests to determine whether your symptoms[4] are because of an underlying condition.
This involves physical examination where the doctor monitors your lungs and heart, examines your penis and testicles and checks your blood pressure.
Besides, the doctor may recommend a rectal exam to determine the condition of your prostate or blood or urine tests to ensure that the symptoms are not as a result of other conditions.
The major test for erectile dysfunction is the nocturnal penile tumescence (NPT) test. This is a test done using a portable, battery-powered device that is attached to your thigh while you are sleeping.
The device helps in evaluating and collecting the quality of nocturnal erections and keeps the data for your doctor to access later. Nocturnal erections refer to erections that occur when you are sleeping, they give a clear sign of proper functioning penis, and therefore they are healthy.
The report acquired from the device helps the doctor to understand better your penis function and the ED condition. Here are common approaches to diagnosing ED:
Health Records of The Patient
One of the most effective ways of diagnosing impotence is examining the health history of the patient. This helps in determining the cause of ED or whether there are other underlying health issues. Therefore, it is good to be candid and speak to your doctor without any feeling of embarrassment. This allows the medical practitioner to identify the cause of the condition and come up with the right method of treatment.
The doctor will also inquire about every medical condition affecting you as well as all the prescribed and non-prescribed medications that you are currently using. The following are some of the common information that your medical practitioner will work to find out while examining your health history:
The doctor tries to identify whether you are experiencing impotence, or a disorder or ejaculation problem or loss of libido or penile curvature problems (Peyronie’s disease) or orgasm.
Identify whether the cause of ED is due to physical factors or psychological such as stress, depression, and anxiety.
The medical professional may inquire whether you experience night or morning erections. Usually, men suffering from psychogenic impotence (ED that results from psychological factors) maintain nocturnal erections.
On the other hand, men with erectile dysfunction that is caused by physical factors like smoking, atherosclerosis, and diabetes do not experience such involuntary erections.
Your doctor may try to link the erectile dysfunction to the root cause of the problems. Besides, the medical professional may also recommend a test to identify whether you are experiencing erections while sleeping.
The doctor will try to determine whether your erectile dysfunction results from physical causes. For instance, if you have a prior history of strokes, heart attacks, smoking cigarettes, and improper blood flow in the extreme parts of the body may suggest the main cause of ED might be atherosclerosis.
On the other hand, loss of libido, sexual desire or sexual fantasies, breast enlargement (gynecomastia), and diminishing* hair suggest that the ED could be due to low levels of testosterone.
Moreover, a previous pelvic radiation history or surgery and any trauma to the perineum/penis/pelvis may also suggest damage to the blood vessels and the nerves. Finally, intermittent claudication symptoms in the lower parts of the body, especially with exercise may be a clear sign that the ED is due to a vascular issue.
Finally, the medical professional will try to identify whether you are taking any medications that can lead to impotence. Remember, it is good to discuss about the medications that you are prescribed or acquired over-the-counter medications with your doctor.
Laboratory Tests
This is mainly the final approach in case other methods of diagnosing ED are unable to identify the cause of the problem. The test done depends on the information found from physical examination, health history, as well as recent lab tests.
The testosterone level might not be necessarily important to all men, but testosterone should be obtained if there are signs and symptoms of low testosterone (hypogonadism). Some of the common laboratory tests that may be done while evaluating erectile dysfunction include:
1. Urinalysis
Urinalysis
This helps in determining the level of blood sugar in your urine. A high protein may suggest damage to your kidney while a high sugar level may be a sign that you are suffering from diabetes mellitus.
2. Blood Components
3. Blood Glucose Levels
Presence of abnormally high glucose levels may be a clear sign of diabetes mellitus.
4. Lipid Profile
Having blood with high levels of LDL cholesterol may suggest that you are suffering from diabetes mellitus.
5. Serum Creatinine
This helps in monitoring the functioning of the kidney. Presence of abnormal serum creatinine may be a sign of a damaged kidney.
6. Hemoglobin AC Tests
Presence of extremely high levels of the component in the blood for patients suffering from diabetes mellitus could suggest that her or his body is unable to control blood glucose levels.
7. Testosterone Levels
This involves obtaining blood samples early in the morning as the testosterone levels keep on fluctuating in the course of the day. It is advisable to check once again if you have a hypogonadism or low testosterone level to ascertain that it is true. However, the doctor may recommend that testosterone be measured in active form for some men.
8. Prostate Specific Antigen (PSA) Levels
Determining the levels of PSA in the blood and prostate is to ensure that you do not have prostate cancer is essential before beginning on testosterone treatment as testosterone can aggravate prostate cancer.
Levels of Other Vital Hormones
Testing of the other hormones like cortisol level, luteinizing hormone and prolactin level helps in providing a hint to the underlying cause of low testosterone levels or erectile dysfunction.
This may occur due to adrenal gland or pituitary gland abnormalities. Moreover, the doctor may also recommend for some patients as both overactive thyroid function (hyperthyroidism), and low thyroid function (hypothyroidism) may lead to impotence.
Liver Enzymes and Liver Function Tests
Testing for liver diseases is important as liver cirrhosis might cause low testosterone levels, which is one of the causes of erectile dysfunction.
Blood Tests
The other potential test in the evaluation of erectile dysfunction includes test for lupus, sickle cell anemia, scleroderma, hemochromatosis and cancers like colon cancer, leukemia. However, these tests might be performed according to on the symptoms and health history of each individual.
Physical Examination
This approach of diagnosing can reveal the clues for physical erectile dysfunction. The process involves analysis of the genitals as part of the evaluation of erectile dysfunction.
Consequently, the doctor will examine your penis to determine if there are any plaques (hard areas) and ask you about penile curvature. The medical professional will also examine the testes to ensure that they are of normal sizes and are in the right location in the scrotum.
Remember lack of facial hair, small testicles, and enlarged breasts can suggest hormonal problems such as low testosterone levels or hypogonadism.
On the other hand, pulses in your feet or groin may also be examined to determine whether there is any sign of hardening of arteries, which could affect the arteries in your sexual organ.
Imaging Tests
These are rarely done in diagnosing of impotence. The tests include Ultrasound with Doppler imaging, which offers additional information blood circulation in the penis. This is important in the diagnosing of erectile dysfunction in patients with previous surgical history.
The test is usually done after a vasodilator (prostaglandin E) is injected into the upper chambers in the penis (corpora cavernosa), which is a chemical that causes arteries to open.
This helps in measuring the rate o blood circulation into the penis and in diagnosing of problems associated with veins compression.
In some cases, an angiogram (involves injecting arteries with a dye) may be performed in cases where vascular surgery may be important. This helps in taking images to determine areas where there is the narrowing of arteries.
Psychosocial Examination
The doctor may ask a question to determine the stressor, relationship issues, events that may contribute to erectile dysfunction if the condition appears to result from psychological factors.
Further Tests
Other health tests may include monitoring nocturnal penile tumescence (erections during sleep), which can help the doctor in determining if the ED is caused by physical or psychological factors. This involves wrapping a band around penis for to successive nights.
The device monitors erections of penis while sleeping at night and how long the erections last. However, it is important to note that having nocturnal erections is not a sign that the person is not suffering from erectile dysfunction.
What Are The Treatments For Erectile Dysfunction?
Treatments For Erectile Dysfunction
Many treatments that help in overcoming erectile dysfunction are available in the market. However, it is important to understand that the treatment of erectile dysfunction[5] depends on the underlying cause.
Your condition might even require you to use a combination of treatments that include medications, therapy, and lifestyle changes.
Common Erectile Dysfunction Medications
In most cases, doctors may prescribe some medications that help in managing your ED symptoms. This will require you to acquire the right medication that works for you, which means that you need the help of a professional.
However, it is important to understand that these medicines can have some side effects. Therefore, it is advisable to consult your doctor in case you experience serious or unpleasant side effects as he or she may recommend a different medication that works for you. Here are the common drugs prescribed to help in stimulating the flow of blood to your penis while treating ED:
Avanafil (Stendra)
Alprostadil (Caverject)
Vardenafil (Levitra)
Testosterone (Androderm)
Sildenafil(Viagra)
Tadalafil (Cialis)
Natural Remedies And Herbs For Erectile Dysfunction
Studies have shown that natural remedies may help in treating ED in some men. However, it is advisable to consult your doctor before tying any new supplement or herb.
This is because many supplements and herbs in the market are not regulated, and thus they may contain additional ingredients, which might not be on the label. Therefore, you should be cautious when buying herbs or supplements and avoid purchasing them online.
You can as well ask your doctor to recommend some of the reputable brands. The following are the common supplements and herbs used in treating ED:
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