Erectile dysfunction is a relatively well known condition in both medicine as well as human experience; but, up until a few years ago, it was a condition that was shrouded in mystery and ignorance and therefore it was never discussed openly. What added to the problem was that cultural expectations of male sexuality acted as inhibitory factors for men and this prevented them from seeking erectile dysfunction treatment that could actually be beneficial.

Temporary erectile dysfunction is quite common and is therefore not considered to be a serious problem. Nevertheless, if the condition persists, the psychological effects can be significant. Impotence can severely impact a healthy relationship and be the prime reason for extreme depression; this can become chronic if left untreated. When sexual dysfunction extends over a consistently prolonged period of time, it can be assumed that a serious physical or emotional disorder may be present.

It has been estimated buy the American Urological Association that erectile dysfunction affects about 25 million American men as any given time. The Massachusetts Male Aging Study was conducted on a random sample of about 1,700 men between the ages of 40 and 70. Researchers found that about 43% of the men had some level of erectile dysfunction. Technically, erectile dysfunction can affect any man who is old enough to have an erection, but it generally increases with age; it is assumed that nearly 5% of men in their 40s and 25% of men in their 60s have complete erectile dysfunction.

What are the symptoms of ED and how is it diagnosed?

Symptoms of erectile dysfunction include your inability to have an erection or to sustain an erection long enough to conclude satisfactory sexual activity. An occasional problem is considered as normal; however, frequent or prolonged problems may require evaluation by a physician.

Erectile dysfunction can be easily diagnosed. It is established through a detailed consultation with your doctor. This consultation is designed to evaluate all the causes of erectile dysfunction. This is usually done through a series of questions as well as a detailed physical examination. Further tests may also be required to establish some of the physical or medical causes of impotence. Blood tests are also conducted to measure blood sugar levels, kidney and liver function as well as hormonal levels.

More specialized tests include an ultrasound of the genital area; this gives a fairly good idea about the blood vessel anatomy and also helps measure the blood flow characteristics in this area. This may involve scanning before and after your penis is injected with a drug that helps create the required erection. In certain cases, more invasive tests are used to find suspected vascular problems. Additionally, a cavernosometry test may be conducted; it helps measure the pressure in the penile blood vessels as well as the sponge-like penile tissue, assessing penile blood flow. Similarly, cavernosography tests may also be conducted; this involves injecting radiographic dye into the penile blood system to see if there is an abnormal leakage of blood that is preventing the actual erection.

What are the causes of ED?

There are many actual possible causes for Erectile Dysfunction. These include:

Psychological causes: Almost one in every three cases has a psychological orientation. At times it becomes difficult to separate the psychological causes from physical causes because of negative emotional state. A stressful period in life can cause the sudden onset of impotence and here the most likely cause could be emotional. Other signs of psychological causes include a man's ability to have an erection when he is sleeping or masturbating, but may not always have an erection during couple sex.

Some of the most common psychological causes include:

• Anxiety; performance related anxiety may provoke a fear of failure and self-doubt, leading to impotence
• Stress; it can be caused by various things, such as financial problems or workplace pressures
• Depression; it can lead to impotence because depression reduces a man's ability to function sexually because of inhibited sexual desire
• Relationship problems; sexual tension or anger towards a partner can directly impact sexual functioning

Physical causes: Lifestyle is generally responsible for most maladies in one's life. A healthy lifestyle has a positive outcome while an unhealthy lifestyle may cause physical conditions either internally or externally that may directly impact your health.

• Socioeconomic issues like losing a job or low income can increase the risk for impotence
• Smoking may lead to impotence; it is known to cause a 26-fold increase in impotence
• Drugs like marijuana and other illicit drugs can cause impotence when used over long periods of time
• Alcohol can depress the central nervous system and impair sexual function
• Exposure to estrogen-like chemicals found in pesticides, may contribute to erectile dysfunction
• Lack of frequent erections deprives the penis of oxygen-rich blood and interferes with blood flow in the long term
• Diabetes (high blood sugar)

Medical causes: Erectile dysfunction due to medical conditions usually develops gradually but continuously over a period of time. If impotence persists over a three-month period and is not due to a known cause then medical intervention is advisable. Certain medical conditions include:

• Medications such as blood pressure lowering medications, tranquilizers, and anti-depressive medications
• Various long-term medical conditions such as stroke, liver or kidney failure, multiple sclerosis and others
• Hardening of the arteries from high cholesterol, high blood pressure or smoking

What are the currently available treatments for ED?

The currently available impotence treatments may not work as impotence cures but can effectively treat the condition. These include:

Sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis): These medications for impotence caused by psychological, physical or both factors were successfully used in 69% of the cases. To date the three impotence treatment drugs are considered to be the easiest, safest and the most effective treatment options. These impotence pills:

• Work only when a man experiences some sexual arousal
• Should not be used more than once a day
• Should be avoided by men taking nitrates, such as nitroglycerin for heart disease
• May cause side effects that are reported to be minor and temporary; they include upset stomach, nasal congestion, headache, and muscle aches
• Are for oral use only

Counseling: Being counseled by a healthcare professional can help sort out the emotional or physical causes of impotence.

Injections: The medications papaverine or prostaglandin, when injected at the base of the penis, produces and erection in most men.

Medical Urethra System for Erection (MUSE): Producing an erection in 15 minutes, a small pellet of the medication alprostadil is inserted into the penile opening; it may sometimes cause pain in the penis.

Vacuum devices: There are many vacuum devices currently available for the treatment of impotence. The penis is placed in a plastic tube and using the suction method, an erection is caused by bringing blood into the penis. Then a rubber ring is placed at the base of the penis to prevent the blood from flowing out of the penis. But, this can be safely used for no more than 30 minutes at a time.

Penile prosthesis: Often removable, these devices are surgically placed in the penis to simulate an erection.

Hormone replacement: Testosterone therapy is usually only offered to men who have medical conditions that cause low testosterone levels.

Who is affected by ED?

As sex is an integral part of life, problems with erections may have an emotional impact on both partners. It is hard to know exactly how many men suffer from impotence at any given time as some men still hesitate to come out in the open. The best estimates are 5% of men by age 40, and 75% of men by age 80.