impotence imposes on relationships
Erectile dysfunction (ED) can lead to a loss of intimacy in a relationship that can affect the mental well-being of both partners.

Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient for penetrative sex. Causes of ED are usually medical, but they can also be psychological.

Many men experience occasional failure to achieve an erection, which can occur for various reasons, such as drinking too much alcohol, stress, relationship problems or being extremely tired. However, it is estimated that about 1 in 10 adult males have ED on a long-term basis. 

ED can lead to a loss of intimacy in a marriage or relationship and affect the mental well-being of both partners. To combat this, couples can help deal with ED in the following ways:

  • Open communication
  • Couples counseling
  • Thorough knowledge about ED

Moreover, doctors and therapists can help couples manage the condition and understand treatment options.

Physiology of Penile Erection

Erectile dysfunction (ED) can occur because of problems at any stage of the erection process. An erection is the result of increased blood flow to the penis. Blood flow is usually stimulated by either sexual thoughts or direct contact.

When a man is sexually excited, the muscles in his penis relax. This allows for increased blood flow through the penile arteries, filling two chambers inside the penis. As the chambers fill with blood, the penis grows rigid. The erection ends when the muscles contract and accumulated blood can flow out through the penile veins.

What causes erectile dysfunction?

Erectile dysfunction (ED) can be caused by numerous factors including:

  • Vascular disease: Blood supply to the penis can become blocked or narrowed because of vascular disease such as atherosclerosis (hardening of the arteries).
  • Neurological disorders (such as multiple sclerosis): Nerves that send impulses to the penis can become damaged from stroke, diabetes or other causes.
  • Psychological states: These include stress, depression, lack of stimulus from the brain and performance anxiety.
  • Trauma: An injury could contribute to the symptoms of ED.
  • Medications: Several prescription drugs may treat a disease or condition, but can affect a man's hormones, nerves or blood circulation, resulting in ED as a side effect.
  • Operations: Operations for prostate, bladder and colon cancer may also be contributing factors to ED.

How is erectile dysfunction diagnosed?

Erectile dysfunction (ED) can be diagnosed as follows:

  • Physical exam: This might include careful examination of the penis and testicles, as well as checking the nerves for sensation.
  • Blood tests: A sample of blood is sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
  • Urinalysis (urine tests): Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
  • Ultrasound: Involves holding a transducer (wand-like device) over the blood vessels that supply the penis to create a video image and see any blood flow problems. This test is sometimes performed in combination with an injection of medications into the penis to stimulate blood flow and produce an erection (penile tumescence studies).
  • Psychological exam: This involves asking questions to screen for depression and other possible psychological causes of ED.

How is erectile dysfunction treated?

The first step to treat erectile dysfunction (ED) is to find the underlying cause, and then, appropriate treatment can begin. The type of medical specialist who treats ED will depend on the cause of the problem. Once determined, numerous non-surgical and surgical options can help a man regain his normal sexual function.

ED can be treated in many ways, such as:

  • Oral medications
  • Sex therapy
  • Penile injections
  • Vacuum devices
  • Intraurethral medication
  • Surgery (penile implant)

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Medically Reviewed on 8/3/2021
References
https://emedicine.medscape.com/article/444220-overview

https://medlineplus.gov/erectiledysfunction.html

https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)