Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Temporary impotence is very common indeed, particularly in younger men, and especially when they are either anxious, or have had too much to drink. It is one of the most common sexual problems and affects around half of all men over 40 at some point. It becomes more common and severe as men get older. However, only a fraction of affected men seek help. Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors, and thus the condition is under-diagnosed. While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. Complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. If you're having erection problems, bear these points in mind:

The most common cause of temporary impotence is anxiety. Impotence can be helped by medication, sex counselling, mechanical AIDS, or - very occasionally - surgical treatment. Impotence may be a symptom of an underlying condition requiring treatment; the most common of these is diabetes.

An erection happens when blood is pumped into the Penis - and stays there - making it stiff and hard. It is a complex process, involving the blood vessels to and within the Penis as well as the Nervous system that controls the flow of blood and, on top of it all, the man's emotional state. Many sorts of influences can therefore stop erections from occurring. . Psychological causes:

Anxiety about 'performance' will almost certainly make it difficult or impossible to get an erection. Problems in a relationship may affect potency. Impotence may be caused by Depression. Bereavement: recent loss of a loved one is notorious for causing impotence. Tiredness. Stress. Hang-ups - for instance, guilt about sex. Unresolved gay feelings.

Physical causes:

Problems with the chemical mechanism that makes erections happen - very common in older men. Vascular (blood vessel) disorders. Patients with Arteriosclerosis, other Heart or vascular diseases and high blood pressure are at greater risk of developing impotence. Excessive drainage of blood from the Penis through the veins (venous leak) - uncommon. Diabetes often creates erection difficulties. Smoking increases the risk of developing Arteriosclerosis and, therefore, of suffering from impotence. Side effects from certain drugs, such as some blood pressure (BP) treatments, some antidepressants and some ulcer healing drugs; antidepressants and BP drugs, in particular, do this very frequently. Side effects of non-prescribed drugs (tobacco, alcohol, cocaine and others). Nervous system diseases - uncommon. Major surgery, eg prostate surgery or other abdominal operations. Hormonal abnormalities - rare.

A man with erectile dysfunction has either a problem getting an erection or difficulty maintaining one. This usually interferes with sexual activity by preventing penetration during intercourse. Erectile dysfunction can occur suddenly or gradually. Some men slowly lose the firmness of their erections or how long the erections last. In other men, especially those whose impotence is largely caused by psychological factors, the problem may occur unpredictably and can improve at any time. Despite their difficulties with erections, men with impotence often continue to have normal orgasm and ejaculation.

Many men feel embarrassed when they first discuss the issue with their doctor or practice nurse. But, particularly since the launch of the drug sildenafil (Viagra), awareness and understanding from health professionals is high and the consultation will almost certainly be less embarrassing than feared. The doctor will ask about your general health and about your erections. This will include whether or not you wake up with an erection in the morning and the strength of the erection compared with the past. The doctor will ask about any medicines you are on, and about any changes in your life that may be having an influence on your sexual health. Your doctor may also want to talk with you and your partner together about any physical or psychological factors that may be contributing to the problem. For example, around the menopause, women may experience pain or discomfort during intercourse. When the man has a faltering erection this may lead to further discomfort for both partners. A physical examination includes taking the blood pressure and checking the pulses in the legs - an indicator of how healthy the circulation is. The Penis and scrotum will be examined. The doctor may request blood tests to look for medical problems, such as anaemia, diabetes, high cholesterol or hormone abnormalities, that might be a contributory factor. More specialised tests to assess blood flow and the way the nerves are working can be done in specialist hospital clinics.

In around 95% of the cases, a suitable treatment can be found. If necessary, referral to a hospital ED clinic may be possible. The simplest treatments are "talking" therapies, and tablets. Treatments for impotence vary a lot and depend on the cause. If the cause is mainly worry, other psychological problems or relationship difficulties - such as arguments and disagreements about sex - then talking to a counsellor or psychosexual therapist will be most helpful.

Lifestyle changes & prevention:

A healthier lifestyle can often be beneficial and can help prevent any further deterioration caused by underlying medical conditions.

If you smoke, make a plan to stop. Take moderate-intensity exercise (so you feel warm and slightly out of breath - brisk walking for instance - for half an hour on most days of the week. Eat a balanced diet rich in fruit and vegetables and low in fat. Drink alcohol in moderation. Other recreational drugs can cause ED. Aim to reduce stresses in your life by looking at the balance between your work and your home/leisure time. Relaxation techniques may be helpful.

Psychotherapy/counseling:

This is mainly for use where the main cause is anxiety, guilt or a hang-up. It's also important to note that whatever form of treatment a man receives, sex counselling may be required. In cases that are entirely due to psychological causes, counselling alone can cure the problem. But even in the other methods, counselling is often necessary as a supplement to the main treatment.

Alteration of medication:

This is useful when the impotence is due to pills that are being taken for high blood pressure or other disorders. A change of medication is often possible and may give fewer side effects.

Medicines for impotence:

Have been developed very successfully in recent years. Many are highly effective, but they are not the sole answer to every man's erection difficulty.

Mechanical AIDS:

Pubic ring: a rubber or bakelite ring that is put around the base of the Penis. It is claimed to be effective for men who can't maintain an erection for very long. Vacuum pump: a tight-fitting cylinder, in which low pressure can be created, is placed over the Penis. The resulting suction gives an erection. Unfortunately, the Penis tends to look blue in colour, and feels cold to the touch.

Surgical treatments:

Splinting: this treatment involves the insertion of a flexible synthetic or metal rod (prosthesis) into the Penis to cause a mechanical erection. There are several different types of prosthesis. It is important to realise that this treatment cannot be reversed without more surgery, so it will not normally be used unless other methods have failed. Sealing a vein leak: unfortunately, this is not always very effective.

In general, the prognosis for men with erectile dysfunction is excellent. Although most cases of impotence have medical causes that cannot be cured, many treatment options will restore sexual function. In addition, there are several permanently curable forms of the disorder, including erectile dysfunction caused by psychological problems, hormonal disorders and traumatic injury to the penile Arteries.

Complications of Impotence are secondary conditions, symptoms, or other disorders that are caused by Impotence. In many cases the distinction between symptoms of Impotence and complications of Impotence is unclear or arbitrary.