Erectile dysfunction (ED) is the inability to attain or maintain an erection, impairing the ability to achieve satisfactory sexual intercourse. There are numerous causes, some treatable and some not. Most common among them are cardiovascular disease (such as arteriosclerosis and hypertension) and diabetes both of which can inhibit blood flow to the penis. Among other causes are neurological problems that can result from prostatectomy surgery, insufficient sex hormones (hypogonadism), side effects from several drugs and even cigarette smoking. Psychological factors can also play a major role.
An erection occurs when, with proper stimulation, blood enters the penis and is held there, making the organ tumescent. This process is reversed by a substance in the blood known as PDE5 which causes the blood to leave the penis, making it flaccid. Treatment for ED is often successful with PDE5 inhibitor drugs, the best known of which are Viagra and Cialis. (Sexual arousal is necessary, as these are not aphrodisiacs.) In more difficult cases, treatment can involve injections into the penis, prostaglandin tablets in the urethra, a penile prosthesis, a penile pump or vascular reconstructive surgery.
–written by Dr. Howard Bellin