The term erectile dysfunction, also known as impotence, refers to the male disorder involving the inability to have - or to maintain - an erection during sexual intercourse. This disorder is more widespread than one might think, especially because many diagnoses are "submerged" as most affected men tend to not talk about it. Epidemiological data reveal that about 152 million men were affected around the world in 1995 and according to estimates this figure could rise to 322 million by 2025.

As mentioned, the main symptom of erectile dysfunction is regular or repeated inability to obtain or maintain an erection. Essentially there are two types of causes of this condition: physical or psychological. The consequences are the same in both cases: difficulty or impossibility of having sexual relations tends to lead to poor self-esteem, stress, dissatisfaction in a relationship and worsening of quality of life. In a vicious circle, these problems can in turn lead to worsening of the erectile dysfunction itself.

When erectile dysfunction has a physical origin, it is usually vascular and/or hormonal. Metabolic syndrome, which causes vascular disorders and testosterone deficiency, is often associated with erectile dysfunction. Known risk factors for the development of erectile dysfunction can be genetic or related to lifestyle. They include diabetes, cardiovascular disorders, hypertension, renal insufficiency, ageing, obesity, the use of certain medications (in particular some chemotherapies and antidepressants), drug abuse and smoking. Several recent studies have shown that appropriate lifestyle modifications can improve sexual function in men with erectile dysfunction.
On the other hand, psychological factors are more common in young people (especially teenagers at early sexual experiences) and are mainly associated with performance anxiety, stress or mental disorders such as depression, schizophrenia, panic attacks, poor self-esteem, or issues with sexual identity.

It should be stressed that occasional failure in achieving or maintaining an erection does not indicate that a man has erectile dysfunction. Such occurrences can have a number of causes, including situational stress, a new partner, fear of pregnancy, overwork, fatigue, feeling unwell, having many erections and ejaculations within a short time. When this occurs, it is important not to worry: fear of failure in achieving an erection as a stress factor can provoke erectile dysfunction.

Suggested readings

  • Hatzimouratidis, K., Giuliano, F., Moncada, I., Muneer, A., Salonia, A., Verze, P., EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism, European Association of Urology, 2017, pp. 7-10
  • Kendirci, M., Nowfar, S., Hellstrom, W.J.G, The impact of vascular risk factors on erectile function, Drugs of Today (2015)
  • Mulhall, J. P., Jenkins, L. C., Nocturnal Penile Tumescence, in Mulall, J., Jenkins, L., Atlas of office Based Andrology Procedures 2017
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