Erectile Dysfunction

Erectile dysfunction is defined as the lack of ability to achieve and maintain an erection sufficient enough to have satisfactory sexual interactions. In males, this develops progressively with aging. This disorder is also referred to as “impotence.” It can cause disturbances in a person’s physical and psychological health along with leading to social isolation because of a lack of confidence or self-esteem. 

The normal sexual response in males has four stages. With Erectile Dysfunction (ED) there is a disturbance in the erection and ejaculation phases because of a parasympathetic disturbance or abnormality of neurotransmitter cascading and it leads to an inability to maintain an erection.

Common risk factors of Erectile Dysfunction

Age is the major and direct risk factor for the erectile disorder (ED). The prevalence regarding age groups is approximately 5% at age 40, and 15%-25% at age 65 or older.

Risk factors for Erectile Dysfunction

ED risk factors can be an indicator of systemic disease such as:

  • Cardiovascular (heart) diseases
  • High blood pressure
  • Diabetes mellitus (DM)
  • Tobacco use
  • Alcohol use
  • Hyperlipidemia (obesity)
  • Hypogonadism
  • Lower urinary tract disorders
  • Metabolic problems
  • Depression

Diagnostic measures used to determine Erectile Dysfunction

Physical exam:

  • Inspection of genitalia
  • History of trauma
  • Questioning of psychosocial stressors
  • Neurological assessment

Blood test:

  • To investigate for low testosterone levels
  • To check other comorbidities
  • Endocrine dysfunction like glucose level in diabetes

Duplex Ultrasound:

  • To check blood flow to the penis
  • To check for atherosclerosis

Overnight erection test:

  • To check if an erection occurs during the dream cycle of sleep
  • To check other psychogenic causes

Types of Erectile Dysfunction

Erectile dysfunction is unsatisfactory penile erection consistently over time that leads to lack of sexual activity and causes psychological distress. There are three types of erectile dysfunction: 

  • A psychogenic erection that occurs due to fantasy/imagination
  • A nocturnal erection occurs during the dream stage of sleep.
  • A reflexogenic erection that occurs by physical stimulation

Erectile dysfunction can occur because of an abnormality in any of the above erection types. Many times it is associated with male aging but it can also be caused by a medical or psychological problem. 

Erectile Dysfunction Causes

The main pathophysiological causes of Erectile Dysfunction include:

  • Psychosocial issues
  • Neurological problems
  • Vascular issues
  • Traumatic experiences
  • Surgical side effects
  • Drugs associated
  • Endocrine

Psychosocial causes:

  • Stress
  • Relationship problems
  • Performance anxiety
  • Depression
  • Other psychological associated disorders

Physiological/vascular causes:

  • Atherosclerosis
  • Hypertension leading to damage of vessels
  • Diabetes mellitus
  • Hyaline arteriosclerosis
  • Chronic renal or liver failure

Neurological causes:

  • Stroke
  • Multiple sclerosis
  • Back trauma leading to nerve damage
  • Parkinson’s Disease
  • Dementia

Endocrine dysfunction:

  • Hypogonadism leading to low testosterone levels
  • Thyroid dysfunction
  • Hyperprolactinemia

Effects of medications:

  • Use of anti-hypertensive drugs like diuretics and beta-blockers 
  • Antidepressants
  • Methadone
  • Alcohol or tobacco smoking

 Traumatic Erectile Dysfunction:

  • Pelvic or penile fractures
  • Pelvic radiation
  • Priapism
  • Spinal Cord Injury

Surgical causes:

  • Radical prostatectomy
  • Porto-iliac vascular surgery
  • proctocolectomy

Symptoms of Erectile Dysfunction – ED Symptoms

Erectile Dysfunction Symptoms are:

  • Trouble achieving erection
  • Inefficient maintenance of an erection during sexual intercourse
  • Inability to get an erection by psychological or physical stimulation
  • Decreased interest in sex

Other associated conditions with impotence include:

Complications of erectile disorder

  • Relationship difficulties
  • Lack of intimacy
  • Decreased ability for inducing pregnancy
  • Elevated stress
  • Depression
  • Anxiety
  • Low self-esteem
  • Social withdrawal
  • Frustrated sex life

Preventive measures for erectile dysfunction

Erectile Dysfunction (ED) can be prevented by some simple measures like:

  • Avoidance of alcohol abuse
  • Losing weight
  • Seeking help for relationship issues
  • Getting evaluated
  • Avoiding smoking
  • Getting a healthy and nutritional diet plan
  • Exercising properly and remaining active
  • Changing prescribed medications or avoiding illicit drug use
  • Getting involved in healthy mind related activities
  • Going for routine medical checkups 

Erectile Dysfunction Treatment Options – ED Treatment

Medications that can help with erectile dysfunction treatment:

  • Sildenafil (Viagra)
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)

These medications work by responding to sexual stimulation.


Other methods that may help to promote an erection in 5 to 20 minutes include:

  • A vacuum erection device. This applies negative pressure around the penis to increase blood flow
  • Intraurethral suppository
  • Alprostadil (MUSE)


  • Phentolamine
  • Papaverine
  • Atropine
  • Alprostadil

Surgical treatment:

  • A penile implant. This is a prosthetic device that does not cause an erection but helps keep the penis rigid

Couples therapy:

Erectile dysfunction can lead to depression and other psychological co-morbidities. Couples therapy with you and your partner can help gain a better understanding of the disorder, the root causes, and how to promote and maintain physical and emotional intimacy while managing erectile dysfunction. 

Physiotherapy for Erectile Dysfunction:

Kegel exercises:

  • Physiotherapists can help by giving exercises to help strengthen pelvic floor muscles.
  • These exercises have urinary and sexual health benefits and are easy to perform.