Erectile Dysfunction - What Is It?

Erectile dysfunction is a medical condition in which a male individual encounters difficulties in achieving or maintaining an erection during sexual activity. The popular and outdated name for this disorder is impotence. The causes of this condition may be related to disruptions in the functioning of blood vessels, the nervous system, psychological aspects, or hormonal imbalances. Certain medications can also affect erectile function.

In 1992, the term "erectile dysfunction" replaced "impotence," thanks to the US Health Institute. According to WHO research, 10% of men aged 21–29 face erection problems, 1 in 5 men aged 30-35, and half of men up to 70. This demonstrates the scale of the problem in our time, and it is predicted that these rates may double within the next 20 years.

Signs of Erectile Dysfunction

I would like to remind you that not only erection problems but any sexual problems can be symptoms of various disorders. It is important to seek help from a doctor as soon as possible, who will determine the causes of the disturbances and refer you to the appropriate specialist.

The first signs of erection problems that worry men include:

• Periodic or constant loss of erection, its absence, or interruption, even with strong arousal.
  
  
• Decreased sexual desire.
  
  
• Lack of orgasm.
  
  
• Inability to perform sexual intercourse.
  
  
• Preference for masturbation over physiological sex.

Read more about the causes and symptoms in our other article.

When can it be said that a man has erectile dysfunction?

An erection is a complex interaction among various systems within the male body, contingent upon the anatomy of the genital organs, the activity of the endocrine and nervous systems, blood circulation in small and large vessels, and mental, psychological, physical, and social well-being.

If we consider diagnostic criteria, a disorder is considered to be present when, in approximately 75%–100% of sexual activity cases, difficulties in achieving and/or maintaining an erection during intercourse are noted in specific or various situations. The problems should manifest or persist for at least 6 months and cause concern for the man.

Unfortunately, many men with these problems may have low self-esteem, a reduced sense of masculinity, and may also be in a depressed mood. Erectile dysfunction is also closely related to feelings of guilt, self-blame, feelings of failure, anger, and worry about disappointing one's partner. Fear and/or avoidance of future sexual contact may arise

Factors Affecting the Occurrence of Erectile Dysfunction

When identifying erectile dysfunction, the following factors need to be considered:

• Partner factors (e.g., sexual problems or the partner's health);
  
  
• Relationship factors (e.g., poor communication, differences in desire for sexual activity);
  
  
• Individual vulnerability factors (e.g., decreased sexual desire);
  
  
• Psychiatric comorbidities (e.g., depression, anxiety);
  
  
• Stress factors, such as job loss or stress;
  
  
• Cultural/religious factors (e.g., prohibitions related to sexual activity, attitudes towards sexuality);
  
  
• Medical factors, in particular, surgical interventions (e.g., transurethral resection of the prostate), hypogonadism or neurological disorders (e.g., multiple sclerosis, diabetic neuropathy), cardiovascular diseases;
  
  
• Substance use (smoking or any psychoactive substances);
  
  
• Medications that may interfere with ejaculation (e.g., use of serotonergic drugs).

Organic and psychogenic erectile dysfunction. What is the difference?

It is possible to distinguish between psychogenic and organic erectile dysfunction. The type of dysfunction will determine the methods.

Psychogenic erectile dysfunction is always unpredictable, has an acute onset, varies depending on the situation and partner, may be attributed to stress or a negative experience, may cause strong anxiety, and there will be no erection issues during masturbation. Erection is restored during sexual intercourse. It often accompanies men under 40.

With organic erectile dysfunction, the development will be gradual but progressive, and it will always manifest during sex during masturbation. It may be a symptom or associated with any organic disease, most commonly diabetes, cardiovascular disease, or Peyronie's disease. We will talk about accompanying or main diseases a little further on.

As men age, the likelihood of experiencing erection problems increases. However, elderly men are less likely to experience worry or concern about their masculinity due to such problems compared to younger men.

Prevalence of Erectile Dysfunction

It may seem surprising to some, but the prevalence of erectile dysfunction varies depending on the country. Unfortunately, there is no statistical data available for each country in open sources, and it is also unclear how the culture of a particular country affects men with erectile dysfunction. However, cultural expectations regarding marital relationships, sexual activity, fertility, and gender roles can influence anxiety, which can lead to erection problems. 

Diagnosis of erectile dysfunction

The following diagnostic tests are conducted for erectile dysfunction:

• Ultrasonographic dopplerography with intravascular administration of vasoactive drugs
  
  
• Dynamic infusion cavernosography
  
  
• Study of the conductivity of the pelvic nerve
  
  
• Testing for low levels of bioavailable or free testosterone in serum
  
  
• Assessment of thyroid gland function
  
  
• Determination of fasting blood glucose levels
  
  
• Evaluation of serum lipid levels

What are the consequences of erectile dysfunction? 

Erection problems can affect fertility and cause both individual and interpersonal disorders. Fear and/or avoidance of sexual contact can hinder the development of intimate relationships.

It is important to consider that erectile dysfunction may develop as a result of some other underlying disease. In that case, the primary disease needs to be diagnosed and treated.

Who often experiences erectile dysfunction?

For example, erectile dysfunction may be associated with other sexual disorders, such as premature ejaculation and decreased libido, as well as anxiety and depressive disorders. The risk of depression is significantly higher in men with erection problems, especially in the first year after the onset of the condition.

Men diagnosed with post-traumatic stress disorder often experience erection problems.

Erection problems are often seen in men with symptoms of lower urinary tract obstruction associated with prostate gland hypertrophy.

Additionally, erectile dysfunction may be associated with dyslipidemia, cardiovascular diseases, hypogonadism, multiple sclerosis, diabetes, and other diseases that disrupt the vascular, neurological, or endocrine functions necessary for normal erectile function.

Please read about the treatment of erectile dysfunction in our other article.

Sources:

EPIDEMIOLOGY OF ERECTILE DYSFUNCTION
https://www.sciencedirect.com/science/article/abs/pii/S0094014305701324

Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)
https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787