Erectile Dysfunction

Erectile dysfunction (ED) is the inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance. It is a symptom, not a diagnosis. A single unsuccessful sexual experience does not establish ED; recurrent or persistent difficulty deserves assessment rather than dismissal as an inevitable effect of aging. An erection requires coordinated vascular, neurologic, hormonal, and smooth-muscle function. Vascular disease is particularly important because penile arteries are small and may show the effects of endothelial dysfunction before larger coronary vessels do. ED can therefore be an early marker of atherosclerotic cardiovascular risk. Diabetes, hypertension, dyslipidemia, smoking, obesity, and established cardiovascular disease all increase risk. Other contributors include diabetic or spinal neurologic injury, multiple sclerosis, pelvic surgery or radiation, medication effects, low testosterone, hyperprolactinemia, depression, anxiety, and relationship stress. Several causes may be present at once. A patient with diabetes and performance anxiety, for example, may have both impaired blood flow and a psychogenic component.