Erectile Dysfunction


Erectile dysfunction (ED), often called impotence, has been defined by the NIH (National Institutes of Health) as the inability to sustain or achieve an erection sufficient for satisfactory sexual activity. That means that virtually every man will at some time have what could be called ED; virtually every man will, at some time, be unable to “perform” sexually.

ED should be thought of as a medical problem only when it happens regularly, consistently, over a considerable period of time, and begins to affect a man emotionally and psychologically, harming his self-esteem as well as his sexual activity. This form of ED is actually very common – and very treatable. The NIH estimated, in 2002, that chronic erectile dysfunction affects between 15 million to 30 million men in the U.S. alone. Unfortunately, because of reluctance to discuss the subject with their doctors, only about 10 percent seek treatment.

But there is evidence that this is changing. Certainly the publicity around the introduction of new drug therapies for erectile dysfunction a few years ago stimulated more open discussion of the problem.

The fact is, it’s important to consult your doctor if you do have chronic ED. That’s because many of its causes are physical and not only can they be successfully treated, but if they’re not treated they may lead to other problems.

Physiology of Erection

The process of erection involves a complex set of coordinated physical and mental events. It begins in the brain. When a man is sexually stimulated (aroused) by physical contact, thoughts, or both, neurotransmitters (chemicals) in the brain send messages along the nerves to the vascular (blood) system. The messages tell the vascular system to increase the amount of blood flowing into the penis.

Inside the penis, surrounding the urethra, are two cylindrical chambers filled with spongy erectile tissue. This tissue fills with blood (becomes engorged) causing the penis to expand and become stiffer and straighter. At the same time, fibrous elastic sheathes around the erectile tissue tighten, so the blood can’t leave the penis and the erection continues. After ejaculation or when sexual stimulation ends, the sheathes loosen, the blood leaves the penis, and the penis returns to its non-erect (flaccid) state.

Erectile Dysfunction and Aging

Erectile dysfunction is not an inevitable result of aging. As men age, they do normally experience changes in their erectile function. It may take a longer time and greater stimulation to get an erection, orgasms may be less intense, and the time between erections may increase. But chronic ED is not inevitable, and age is not a reason to avoid treatment.

Additional Resources

American Foundation for Urologic Disease
American Urological Association
Men’s Health Network
Urology Channel
Impotence Institute of America
National Kidney and Urologic Diseases
American Diabetes Association

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