What is erectile dysfunction?
The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.

Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.

Such problems contribute to loss of confidence and inadequacy. Erectile dysfunction occurs in 5% of all males above 40 years of age and this percentage increases with advancing age. When erectile dysfunction proves to be a pattern or a persistent problem, it can interfere with a man's self-image as well as his and his partner's sexual life. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.


What is the cause?
The penis consists of large open spaces confined within a tight capsule. These spaces contain blood. Erection is brought about by a complex method of influences that travel from the brain, originating in the hormonal system and acting through the peripheral nerves. These result in the filling up of the spaces with blood, and this blood cannot flow out. This engorgement of the spaces with blood makes the penis rigid. Once the influences are withdrawn, as after orgasm and ejaculation, blood drains out from the spaces making the penis flaccid.

A. Nonphysical causes : Nonphysical causes may account for impotence. They may include:

Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
Negative feelings. Feelings that you express toward your sexual partner — or that are expressed by your sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.

B. Physical causes: Physical causes account for many cases of erectile dysfunction and may include:

* Nerve damage from longstanding diabetes (diabetic neuropathy)
* Cardiovascular disorders affecting the blood supply to the pelvis
* Certain prescription medications
* Operations for cancer of the prostate
* Fractures that injure the spinal cord
* Multiple sclerosis
* Hormonal disorders
* Alcoholism and other forms of drug abuse

How is it diagnosed?
It's normal to experience erectile dysfunction on occasion. But if erectile dysfunction lasts longer than two months or is a recurring problem, one needs to see the doctor for a physical examination.

Although erectile dysfunction is seen as a personal or embarrassing problem, it's important to seek treatment. In many cases, erectile dysfunction can be successfully treated. The doctor will take a detailed medical history to determine whether this is due to an physical illness or due to psychological problems. Similarly, a detailed examination of the body including examination of the sexual organs will be done. Blood tests may be done to exclude diabetes or high cholesterol. Specialised tests may be done in specific instances to locate a problem in the structure and function of the penis.

How is it treated?
A wide variety of options exist for treating erectile dysfunction. They include everything from medications and simple mechanical devices to surgery and psychological counselling. The cause and severity of the condition are important factors in determining the best treatment or combination of treatments.

Erectile dysfunction due to a psychological problem is treated with much care. Usually the problem is due to performance anxiety, guilt, depression or a fear of failure. The patient is explained that this only worsens the problem. Sex education helps correct misinformation and ignorance about normal sexual practice. In married couples, discussing the problem with both partners may help the doctor to arrive at the root cause of anxiety or performance failure. These treatment sessions are usually time-consuming and slow.

The psychological treatment can be supplemented with the help of medicines that stimulate erection. These can be taken orally like sildenafil (viagra) or others that can be injected into the penis like papaverine or alprostadil, a synthetic prostaglandin. For men with low levels of male sex hormone, testosterone, this hormone may need to be supplemented. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. In some cases that do not satisfactorily respond to medicines, erections can be achieved with the help of appliances like vacuum devices or the insertion of implants into the penis by an operation.

What is the prevention?
Although most men experience episodes of erectile dysfunction from time to time, one can take the following steps to decrease the likelihood of occurrences:

* Limit or avoid the use of alcohol and other similar drugs
* Stop smoking
* Exercise regularly
* Reduce stress
* Get enough sleep
* Deal with anxiety or depression
* See the doctor for regular checkups and medical screening tests

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