What is Erectile Dysfunction (ED)?

Erectile dysfunction (ED) is defined as the consistent inability to obtain or maintain an erection for satisfactory sexual relations. Data from the Massachusetts Male Aging Study has indicated that the prevalence of erectile dysfunction of any degree is 39% in men 40 years old, and 67% in those aged 70 years. This extrapolates to over twenty million men in the United States alone with ED. Effective therapy has been available for some time and currently includes pills, urethral suppositories, vacuum devices, penile injection and a variety of surgical treatment including penile implants.

Medical Conditions Associated With Erectile Disfunction

Atherosclerosis is the cause of approximately 40% of erectile dysfunction in men older than 50 years. Among the most commonly recognized conditions associated are high blood pressure, lipid problems (cholesterol, triglycerides), diabetes and cigarette smoking. In patients with diabetes mellitus, irrespective of type, the prevalence of erectile dysfunction is approximately 50% (range 20 to 75%) with the prevalence dependent on patient age, duration of diabetes and severity of the diabetes. Other chronic disease states associated with a high prevalence of erectile dysfunction include chronic renal failure, hepatic failure, multiple sclerosis, Alzheimer's disease, sleep apnea, and chronic obstructive pulmonary disease. Endocrine disorders such as low testosterone, and thyroid problems may be associated also with ED. Pelvic trauma, pelvic surgery (major prostate, bladder and bowel operations), and pelvic radiation therapy are associated with erectile dysfunction. Direct trauma to the perineum (bicycle injury) can cause vascular problems in the penis and lead to erectile dysfunction that may be treatable by penile artery bypass surgery.

Many medications including certain blood pressure pills, cold medications, hormones, antidepressants, tranquilizers, alcohol, tobacco, heroin, and cocaine are associated with erectile dysfunction.

Common conditions associated with Erectile Dysfunction

  • Diabetes
  • High blood pressure
  • Lipid disorders
  • Cigarette smoking
  • Coronary artery disease
  • Heart attack
  • Stroke
  • Parkinson's disease
  • Multiple sclerosis
  • Herniated lumbar disc
  • Medications (see above)
  • Thyroid problems
  • Low testosterone level
  • Major prostate surgery
  • Major bladder surgery
  • Major rectal surgery

Suggested Reading

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  2. Feldman HA et al. Impotence and its medical and psychological correlates: results of Massachusetts male aging study. Journal of Urology 151:54-61, 1994.
  3. Keil JE et al. Self-reported sexual functioning in elderly blacks and whites. The Charleston Heart Study experience. Journal of Aging Health 4:112, 1992.
  4. Schein M et al. The frequency of sexual problems among family practice patients. Family Practice Research Journal 7:122, 1988.
  5. Slag MF et al: Impotence in medical clinic outpatients. JAMA 249:1736, 1983.
  6. Junemann KP et al. Pathophysiology of erectile dysfunction Semin Urol 8:80, 1990.
  7. Morley JE et al. Sexual dysfunction in the elderly male. Journal of the American Geriatric Society 35:1014, 1987.
  8. Kaiser FEK et al. Impotence in diabetic men. American Journal of Medicine 85:147, 1988.
  9. Shabsigh R. Cigarette smoking and other vascular risk factors in vasculogenic impotence, Urology 38:277, 1991.
  10. Zonszein J. Diagnoses and management of endocrine disorders of erectile dysfunction. Urologic Clinics Of North America 22:789-802, 1995.
  11. Goldstein I et al. Drug-induced sexual dysfunction. World Journal of Urology 1:239, 1983.
  12. Melman A et al. Evaluation of sexual dysfunction in men with severe chronic alcoholism. Journal of Urology 133:187A, 1985.
  13. Kaufman JM et al. Impotence and chronic renal failure. A study of the hemodynamic pathophysiology. Journal of Urology 151:612, 1994.
  14. Lilius HG et al. Sexual problems in patients suffering from multiple sclerosis. Journal of Chronic Diseases 29:643, 1976.
  15. Goldstein I et al: Neurologic abnormalities in multiple sclerosis. Journal of Urology 128:541, 1982.
  16. Mumarriz R, Quingwei RY, Goldstein I: Blunt trauma: The pathophysiology of hemodynamic injury leading to erectile dysfunction. Journal of Urology 153:1831, 1995.