Erectile dysfunction (ED) refers to a man's inability to obtain and maintain an adequate erection for sexual activity. Most men occasionally experience ED, which is normal. However, ED is more common in men older than 65 but can affect men at any age. Therefore, as men age, they may notice that erections may take longer to develop, may not be as rigid as the once were or may require direct stimulation. When ED becomes a continuous problem, it can interfere with a man's psychological wellbeing as well as he and his partner's sex life. It is important to keep in mind that ED may also be a sign of an underlying physical illness that should be treated.

Symptoms
Symptoms of erectile dysfunction (ED) include the following:

• The frequent inability to obtain a full erection.
• The complete inability to achieve an erection.
• The inability to maintain an erection throughout sexual intercourse.

Causes and risk factors of erectile dysfunction
There are many causes of erectile dysfunction (ED), some physical and some psychological. Occasionally, ED may be caused by both physical and psychological factors. However, ED can be one of the first signs of an underlying physical illness. Your physician can help you determine what is causing the ED and work out a treatment that is right for you.

Physical causes and risk factors

• Cardiovascular disease that affects the blood supply to the pelvis
• Kidney disease
• Diabetic neuropathy, i.e., nerve damage resulting from diabetes
• Surgery or treatment for prostate or bladder cancer
• Injury to the spinal cord
• Multiple sclerosis
• Hormonal disorders, specifically low levels of testosterone
• Prescription medications such as antidepressants, antihistamines and tranquilizers
• Substance abuse including alcohol, marijuana and tobacco

Psychological causes

• These causes may include stress, anxiety, fatigue, and depression.
• Negative feelings towards one sexual partner.

Diagnosis of erectile dysfunction
A patient's medical history and recent physical and emotional changes will play an important role in diagnosing erectile dysfunction (ED). Blood tests to check for diseases and disorders such as low hormone levels, diabetes and heart disease may also be necessary. Other tests to check for physical causes of ED may include:

Cavernosometry. This test measures penile vascular pressure.

Cavernosography. This test involves injecting a dye into the blood vessels to view any possible abnormalities in blood flow into and out of the penis.

Ultrasonography. This test determines the adequacy of arterial circulation in the genital organs.

Neurologic evaluation. Your doctor may check for possible nerve damage by conducting a physical examination to test for touch sensation in your genital area.

If your doctor suspects that your ED is caused by psychological factors, it is important to note whether erections are attained during masturbation, with a partner or during sleep. A test that call for wrapping a strip of perforated tape around the penis before going to sleep can confirm whether an erection has occurred during sleep. Tests of this type determine whether there is a physical abnormality causing ED.

Treatments
Several treatments are available for erectile dysfunction (ED). Which treatment you and your doctor choose will depend on its cause and severity. However, the following treatments are available.

Oral medications. A variety of drugs (phosphodiesterase inhibitors) increase the blood flow to the penis allowing an erection in response to physical and psychological sexual stimulation. Their effectiveness vary as well as their duration and side effects. Generally, many men find these medications effective regardless of the cause of the ED. However, men who have had a heart attack, stroke or arrhythmia or who take drugs for heart problems should not take these medications.

Alprostadil. This drug is a synthetic version of prostaglandin E, a hormone that enhances blood flow to the penis. It can be administered two ways: directly into the penis by injection with a very fine needle or through a suppository placed inside the urethra.

Vascular surgery. This type of surgery is most often used when a man has injuries to the penis or pelvic area or who have vascular blockages that interfere with blood flow to the penis.

Penile implants. Because of its expense and the risk of complications, penile implants are not often recommended until other methods to correct ED have been tried. This treatment calls for surgically implanting a semi-flexible device into the penis thus allowing erections to occur.

Psychological counseling. Should you and your doctor suspect that anxiety, depression or stress is causing ED, psychological counseling for you and perhaps your partner may be helpful.

Prevention
The following simple steps can help decrease the chances of experiencing erectile dysfunction (ED).

• Get plenty of exercise and rest
• Limit alcohol intake
• Quit smoking
• Seek help for anxiety and depression
• Minimize stress