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Conditions InDepth: Erectile Dysfunction (Impotence)
by Ricker Polsdorfer, MD
Erectile dysfunction is the inability to attain or maintain an erection of the penis that is firm enough for penetration during sexual intercourse. The condition is also called impotence. To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this blood fill. The nerves prompt certain blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.
The following factors can cause erectile dysfunction:
Venous Leak: Veins are compressed when blood fills the penis. This will help trap the blood in the penis. If these veins are not fully compressed, then blood can leave the penis. The inability to keep blood in the penis will make it difficult to reach or keep an erection. The compression of the veins may not occur, or may be weaker than it should if the blood vessels that are supposed to fill do not fill enough. Blood vessels may not fill enough because of injury or disease.
Neurovascular Function: Erection cannot be attained if nerve signals do not prompt blood vessels to do their job or if blood flow to the penis is reduced. Nerve problems can also diminish feeling in the penis, resulting in impotence.
Many medications can cause erectile dysfunction by impairing either vascular or nerve function.
Medical conditions that can lead to neurovascular dysfunction include:
Psychological Factors: Psychological factors account for 10%-15% of erectile dysfunction cases. The brain initiates many of the nerve signals required for a successful erection. Problems in your relationship, feelings of guilt associated with sex, depression, anxiety, and stress can all lead to erectile dysfunction
An estimated 25-30 million US men have erectile dysfunction. Erectile dysfunction increases with age, affecting about 20% of men aged 20 and older and 78% of men aged 75 and older.
What are the risk factors for erectile dysfunction?
What are the symptoms of erectile dysfunction?
How is erectile dysfunction diagnosed?
What are the treatments for erectile dysfunction?
Are there screening tests for erectile dysfunction?
How can I reduce my risk of erectile dysfunction?
What questions should I ask my doctor?
What is it like to live with erectile dysfunction?
Where can I get more information about erectile dysfunction?
Erectile dysfunction. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 29, 2016. Accessed October 4, 2016.
Erectile dysfunction. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at:
...(Click grey area to select URL)
Updated November 2015. Accessed March 8, 2016.
Erectile dysfunction. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed March 8, 2016.
Guay AT, Spark RF, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of male sexual dysfunction: a couple’s problem. 2003 update. Endocr Pract. 2003;9:77-95.
Sivalingam S, Hashim H, et al. An overview of the diagnosis and treatment of erectile dysfunction. Drugs. 2006;66:2339-2355.
Webber R. Erectile dysfunction. Clinical Evidence. 2005;13:1120-1127.
Last reviewed March 2016 by Adrienne Carmack, MD
Last Updated: 3/15/2015