Erectile dysfunction (ED) has become an issue only in the late years, because before the 20th century individuals often did not live beyond the reproductive years. It is characterized by the regular or repeated inability to obtain or maintain an erection during sexual intercourse. It is quite common condition among men which is to some extent age related; occurs frequently in men between the ages of 40 - 70. There are many reasons why men can suffer from erectile dysfunction; it is the result of a complex interaction of psychological, neural, vascular and endocrine factors. It can also be due to high consumption of alcohol, smoking, diabetes, high cholesterol, obesity, heart diseases or the cause can have psychological origin such stress, performance anxiety or depression. Also medications may potentially worsen sexual function. 

From physiological perspective, a problem might be in arteries or veins. Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is a cause of erectile dysfunction in males, often inflicting young men, unlike other organic causes of erectile dysfunction. Venous leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the artery. The reason of venogenic erectile dysfunction is not exactly known. It might be due to large venous channels draining corpora cavernosa or diabetes. Erectile dysfunction may occur in the early stages of diabetes and is one of the complaints of diabetic patients. 

A spinal cord injury (SCI) can also significantly affect a penile erection. SCI is an injury to the spinal cord resulting in a change, either temporary or permanent, in the cord's normal motor, sensory, or autonomic function. Common causes of damage are trauma (car accident, gunshot, falls, sports injuries, etc.) or disease (transverse myelitis, polio, spina bifida, Friedreich's ataxia, etc.). Sexual function is often affected by an injury and problems that can occur include erectile dysfunction and loss of ability to ejaculate. 

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. It might be rather the secondary reaction to physical impossibility. Psychological causes of erectile dysfunction include stress, traumatic sexual experiences, (performance) anxiety or depression. Stress might be induced by several factors (e.g. job-related problems or relationship concerns). Alcohol or drug abuse could also contribute to erection failure. Anxiety is frequently related to worries and fear of sexual failure; not being able to satisfy partner. Another cause could be depression affecting individual on mental as well as physical level. Depressed people experience feelings of sadness, helplessness, sleeping disturbances as well as fatigue and all these factors could lead to loss of sex drive and erection problems. Low-self-esteem and side effects of various medications could also be significant factors contributing to erectile dysfunction. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image. It is important to realize that it can happen that sometimes the erection might not occur, nevertheless, after few days problem can be resolved. If the problem is persistent and causing a distress and interpersonal difficulty, it is recommended to seek a professional help. 

Associated diseases

  • cavernosal disorders
  • neurogenic disorders
  • psychological disorders
  • kidney failure
  • diabetes mellitus
  • multiple sclerosis
  • atherosclerosis


As a result of ED an individual can experience  stress, anxiety, depression and self-esteem, shame, and altogether it can significantly affect his relationship with a partner.

Risk factors

As was mentioned above, feelings of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which heightens the feelings of inadequacy that already accompany infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency; emotional reactions to the infertility may alter or even undermine a previous consolidation of a sense of self as sexually adequate. Infertility weighs on many males' minds; this creates mental instability, which often results in impotence. Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. Thus, it is important to keep in mind that it can be helped if the roots of stress are detected. Talking to a partner about worries,changing life-style and/or maintaining work-life balance can decrease the likelihood of erectile dysfunction.

To prevent ED one should maintain: a healthy diet, exercise regularly, review medication which could contribute to ED and find potential substitutions for those and also avoid smoking. Apart from that stress reduction techniques and open communication with partner could also decrease the risk of ED.
The early detection of medical problems which may underlie erectile dysfunction is important. By accepting and controlling these health problems, the damage done to tissues of the body, including the penis, may be reduced. Men which they move into middle age, should have regular health checks and they should stop smoking, limit alcohol, don't use drugs, exercise regularly and reduce stress.


Changing life-style (change diet, decrease the alcohol consumption or stop smoking) could help in treatment of ED. Apart from that, for instance, an aphrodisiac could help. An aphrodisiacis a substance that, when consumed, increases sexual desire. Aphrodisiacs are distinct from substances that address fertility issues such as impotence or secondary sexual (dys)function such as erectile dysfunction.

Throughout history, many foods, drinks, and behaviors have had a reputation for making sex more attainable and/or pleasurable. However, from a historical and scientific standpoint, the alleged results may have been mainly due to mere belief by their users that they would be effective (placebo effect). Likewise it is noteworthy that many medicines are reported to affect libido in an inconsistent or idiopathic ways: enhancing or diminishing overall sexual desire depending on the situation of subject.


Cognitive Behavioral Therapy (CBT) or sex therapy could be helpful in treatment of psychological problems which could be contributing to erectile dysfunction. For sex the mind and body cooperation is very crucial and sometimes persistent feelings of stress and anxiety may actually lead to problems with erection. Anxiety, stress or even relationship troubles could be addressed during counselling. Also sex therapy which is focused on improving overall relationship between partners could be useful for some people. Sex therapy is aimed to overcome sex difficulties and is led by trained mental professionals or psychologists.

A phosphodiesterase type 5 inhibitor 

It is is a drug used to block the degradative action of cGMP-specific phosphodiesterase type 5 (PDE5) on cyclic GMP in the smooth muscle cells lining the blood vessels supplying the corpus cavernosum of the penis. These drugs areused in the treatment of erectile dysfunction and were the first effective oraltreatment available for the condition. Sildenafil was the prototypical memberof the PDE5 inhibitors (now, many other agents, both natural and synthetic areavailable). Sildenafil, sold as Viagra and other trade names, is a medication used to treat erectile dysfunction and pulmonary arterial hypertension. Its effectiveness for treating sexual dysfunction in women has not been demonstrated. Its primary competitors are tadalafil (Cialis) andvardenafil(Levitra).

Common side effects of taking PDE5 inhibitors include headaches and heart burn, as well as flushed skin. Caution is advised in those who have cardiovascular disease. Rare but serious side effects include prolonged erections, which can lead to damage to the penis, and sudden-onset hearing loss. Sildenafil should not be taken by people who take nitrates suchas nitroglycerin, as this may result in a severe and potentially fatal drop inblood pressure.


Yohimbine has been used in the treatment of impotence.It is also alleged to be an aphrodisiac. Nevertheless, Yohimbine exerts astimulating action on the mood and may increase anxiety. Its effect on blood pressure, if any, would be to lower it; however, no adequate studies are at hand to quantitate this effect in terms of Yohimbine dosage.

Apomorphine hydrochloride

Apomorphine hydrochloride was a therapy used in the treatment of erectile dysfunction. It is its mode of stimulating dopamine in the brain which is believed to enhance the sexual response. Around 65-70% of doctors felt it was ineffective, with 60% of over 11,000 patients (avg age 61)discontinuing in month 1 and a further 23% in month 2. (UK studies concentratedon males with generalized erectile dysfunction). Apomorphine affects desire and is not meant to produce a systemic effect unlike drugs such as Viagra, which affect circulation. In those males who have problems with desire as opposed to generalized erectile dysfunction, it works as expected.


There is an injectable three-drug prescribed medication called Trimix, which is  also used to treat erectile dysfunction. The injection must be compounded by a pharmacy and administered via intracavernosal injection (an injection at the base of the penis). Trimix is typically compounded by a pharmacy in a sterile environment and then frozen. The compound is stable for up to 6 months while stored frozen and for 1 month if stored refrigerated beginning at the time of manufacture.

Surgical therapy

Inflatable penile prosthesis

In patients with ED, inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate.

There are two primary types of penile prosthesis: noninflatable, semirigid devices and inflatable devices. Noninflatable, semirigid devices consist of rodsim planted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal.

Hydraulic,inflatable prosthesis also exist and were first described in 1973 by BrantleyScott et al. These saline-filled devices consist of inflatable cylinders placedin the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After successful sexual relations, the pump can be deactivated to return the penis to a flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement.

The first-line method for sperm retrieval in men with spinal cord injury is penile vibratory stimulation (PVS). The penile vibratory stimulator is a plier-like device that is placed around glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation.

If there is a significant number of sperm and/or there is any other dysfunction, the retrieved sperm is placed inside woman’s uterus. This process is called intrauterine insemination (IUI).

 If the number of sperm is not sufficient or the procedure is not successful, surgical methods of the sperm retrieval can be used (TESE, MESA, PESA, micro TESE). These techniques are used to collect the spermatozoa suitable for egg fertilization by intracytoplasmic sperm injection (ICSI).

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Erection ―sourced from Wikipedia licensed under CC BY-SA 3.0
Erectile dysfunction ―sourced from Wikipedia licensed under CC BY-SA 3.0
Spinal cord injury ―sourced from Wikipedia licensed under CC BY-SA 3.0
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Psychological effects of male infertility ―sourced from Wikipedia licensed under CC BY-SA 3.0
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