Erectile dysfunction or impotence is the condition where a man cannot have an erection or cannot maintain it long enough for coitus. It can happen to everyone once in a while, but it can cause concern if it has been an ongoing issue. It affects the relationship and also dampens self-confidence. It can also point to an underlying health condition that needs attention.

A male arousal and erection is very complex and brings together the brain, emotions, hormone, muscles, blood vessels and nerves. An issue with any of these can cause a problem. Mental health issues and stress can also cause erectile dysfunction or can worsen it. Sometimes it is a combination of physical, mental and physiological problems that lead to this condition.

Physical causes

• Clogged blood vessels
• Heart disease
• High blood pressure
• High cholesterol
• Diabetes
• Metabolic syndrome
• Obesity
• Multiple sclerosis
• Parkinson’s disease
• Use of tobacco, alcohol or illicit drugs
• Medications
• Sleep disorders
• Peyronie’s disease (scar tissue in the penis)
• Cancer treatment
• Treatment for enlarged prostate
• Low testosterone
• Surgeries in the pelvic area and/or the spinal cord
• Trauma to the pelvic area and/or the spinal cord

Psychological factors

• Depression
• Anxiety
• Other mental health conditions
• Stress
• Issues in relationship

• Trouble having an erection
• Trouble maintaining an erection
• Lack or decreased sexual desire

• Medical conditions like diabetes and heart diseases
• Use of alcohol, drugs and tobacco
• Obesity
• Medical procedures like radiation therapy for cancer or prostate surgery
• Trauma
• Certain medications
• Psychological issues

In most people, a history and physical exam can help the fertility expert to diagnose erectile dysfunction. Further tests include

• Blood tests to rule out heart diseases, diabetes or hormonal imbalances.
• Urine tests to look for underlying conditions like diabetes.
• Ultrasound to diagnose problems with blood flow.
• Psychological exams to see if mental health issues is what is resulting in erectile dysfunction.

• Treatment of underlying conditions
• Oral medications like Viagra, Avanafil and Tadalafil help get and maintain erections. Alprostadil self-injection and urethral suppository can also be prescribed.
• Testosterone replacement if the erectile dysfunction is due to hormonal imbalance.
• Penis pumps, surgery and implants can be used to help attain an erection.
• Regular exercise can also improve erectile dysfunction
• If the condition has psychological roots, psychological counselling can help treat it.